You act as the doctor in public health center and be pleased to analyse this case.

Transkripsi

1 Skenario D Blok 23 Mrs. Tari, 37 years old, from middle income family comes to doctor at a public health center with chief complain of vaginal bleeding. Mrs. Tari also complain abdominal cramping. She missed her period for about 8 weeks. She also feel nauseous, sometimes has vomit and breast tenderness. Since 1 year ago, she has been complaining about vaginal discharge with smelly odor and sometimes accompanied by vulvar itchy. She already has 2 children before and the youngest child is 6 years old. Her husband is a truck driver. You act as the doctor in public health center and be pleased to analyse this case. In the examination findings : Palpebral conjunctiva normal, breast : hyperpigmented, abdomen : flat and soufflé, symmetric, uterine fundus is not palpable, there are no mass, no painful tenderness, and no free fluid sign. Internal examination : Speculum examination : portio is livide, external os opens with blood comes out from external os, there are no cervical erotion, laceration or polyp. Bimanual examination : cervix is soft, the external os opens, no cervical motion tenderness, uterine size is about 8 weeks gestation, both adnexa and parametrium are within normal limit. Hb 11g/dl, WBC 12000/mm3, ESR 15mm/hour, Peripheral blood image : WNL Klarifikasi Istilah 1. Perdarahan vagina 2. Abdominal cramping 3. Mual muntah 4. Breast tenderness and hyperpigmented 5. Vaginal discharge 6. Vulvar itcy 7. Smelly odor 8. Flat and soufflé 9. Portio livide 10. G3P2A0 11. Leukositosis

2 Identifikasi Masalah 1. Mrs. Tari, 37 years old, from middle income family comes to doctor at a public health center with chief complain of vaginal bleeding. Mrs. Tari also complain abdominal cramping. 2. She missed her period for about 8 weeks. She also feel nauseous, sometimes has vomit and breast tenderness. 3. Since 1 year ago, she has been complaining about vaginal discharge with smelly odor and sometimes accompanied by vulvar itchy. 4. She already has 2 children before and the youngest child is 6 years old. Her husband is a truck driver. 5. In the examination findings : Palpebral conjunctiva normal, breast : hyperpigmented, abdomen : flat and soufflé, symmetric, uterine fundus is not palpable, there are no mass, no painful tenderness, and no free fluid sign. 6. Internal examination : Speculum examination : portio is livide, external os opens with blood comes out from external os, there are no cervical erotion, laceration or polyp. Bimanual examination : cervix is soft, the external os opens, no cervical motion tenderness, uterine size is about 8 weeks gestation, both adnexa and parametrium are within normal limit. 7. Hb 11g/dl, WBC 12000/mm3, ESR 15mm/hour, Peripheral blood image : WNL

3 Analisis Masalah 1. Mrs. Tari, 37 years old, from middle income family comes to doctor at a public health center with chief complain of vaginal bleeding. Mrs. Tari also complain abdominal cramping. a. Apa yang dimaksud dengan keluarga berpendapatan menengah? 1 b. Jelaskan hubungan riwayat G3P2A1 dengan aborsi! 2 c. Jelaskan hubungan usia ibu dan resiko aborsi! 3 d. Jelaskan hubungan usia kehamilan dengan resiko aborsi? 4 e. Jelaskan hubungan resiko aborsi dengan pendapatan menengah! 5 f. Jelaskan etiologi dan mekanisme perdarahan pervaginam! 6 g. Jelaskan etiologi dan mekanisme kram perut! 7 h. Jelaskan kaitan antara kram perut dan perdarahan pervaginam! 8 i. Apa saja gejala klinis dari aborsi? 9 j. Apa saja etiologi dari aborsi? 10 k. Jelaskan epidemiologi aborsi! 11 l. Jelaskan klasifikasi dari aborsi! 12 m. Jelaskan patogenesis dari aborsi! She missed her period for about 8 weeks. She also feel nauseous, sometimes has vomit and breast tenderness. a. Apa makna klinis dari terlambat menstruasi 8 minggu? 14 b. Jelaskan patofisiologi dari mual, muntah, dan nyeri pada payudara ketika hamil! Since 1 year ago, she has been complaining about vaginal discharge with smelly odor and sometimes accompanied by vulvar itchy. Her husband is a truck driver. a. Jelaskan mekanisme dari vaginal discharge dengan smelly odor dan vulvar itchy! 16 b. Jelaskan hubungan antara pekerjaan suaminya dengan keluhan yang diderita 1 tahun yang lalu! 17 c. Jelaskan hubungan antara keluhan setahun yang lalu dengan aborsi! She already has 2 children before and the youngest child is 6 years old. a. Berapa jarak ideal antar kehamilan? 19 b. Jelaskan hubungan antara jarak kehamilan 6 tahun dengan aborsi! In the examination findings : Palpebral conjunctiva normal, breast : hyperpigmented, abdomen : flat and soufflé, symmetric, uterine fundus is not palpable, there are no mass, no painful tenderness, and no free fluid sign. a. Jelaskan interpretasi dan mekanisme abnormal dari hasil pemeriksaan fisik? 21

4 6. Internal examination : Speculum examination : portio is livide, external os opens with blood comes out from external os, there are no cervical erotion, laceration or polyp. Bimanual examination : cervix is soft, the external os opens, no cervical motion tenderness, uterine size is about 8 weeks gestation, both adnexa and parametrium are within normal limit. a. Jelaskan interpretasi dan mkanisme abnormal dari hasil pemeriksaan dalam! 22 b. Jelaskan cara melakukan pemeriksaan in speculo dan bimanual! Hb 11g/dl, WBC 12000/mm3, ESR 15mm/hour, Peripheral blood image : WNL a. Jelaskan interpretasi dan mekanisme abnormal dari hasil pemeriksaan laboratorium! Diagnosis banding Cara menegakkan diagnosis (pemeriksaan penunjang) Diagnosis kerja Patogenesis Penatalaksanaan Pencegahan Komplikasi Prognosis SKDI 33 Hipotesis Mrs. Tari, 37 tahun, G3P2A1, mengalami aborsi disebabkan infeksi dan usia LI : aborsi, anatomi dan fisiologi reproduksi wanita Pembagian tugas : 1.Ivandra -1,13,25,4,16,28 2.Eliya-2,14,26,5,17,29 3.Nuria-3,15,27,6,18,30

5 4.Ni Made-4,16,28,7,19,31 5.Dodi-5,17,29,8,20,32 6. Keyshia-6,18,30,9,21,33 7.Arie-7,19,31,10,22,1 8.Keran-8,20,32,11,23,2 9.Faris-9,21,33,12,24,3 10.Ambhi-10,22,1,13,25,4 11.Tri Indah-11,23,2,14,26,5 12.Jesh-12,24,3,15,27,6 Times new roman,12, space 1.5 dan masukkan daftar pustaka. Jangan lupa dicari definisi di klarifikasi istilah