GERIATRY & GROWTH DEVELOPMENT SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY

STUDENTS MODULE

Given to 6th Semester Medical Students Of Hasanuddin University

Created By dr. Femi Syahriani, SpPD. dr. Wasis Udaya, SpPD.

GERIATRY & GROWTH DEVELOPMENT SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY 2011

INTRODUCTION
These modules are designed for the sixth semester students of Medical Faculty, as part of the Geriatry and Growt Development System Curriculum. The module is completed with scenarios that represent the signs and symptoms, as well as the risk factors which frequently found in certain diseases among elderly people. The students are expected to discuss not only the chief complain (as the main problem) of the scenario, but also everything that considered asscociated to it, e.g. diseases pathomechanism in which the students must discuss about the related anotomy, physiology and biochemical process. The ultimate goal is directed more to the problem solving process rather than the diagnosis.

The students are expected to be able to explain all aspects about normal diuresis control, the changing process in the urinary tract due to aging process, the causative factors and its cathegorization, and the treatment of urine incontinence for elderly people.

Prior to the PBL process, both students and turors must read the goals and objectives of the module to assure the prosess is accomplished according to the designated objectives, as well as to achieve the desired competition. Discussion materials can be obtained either from lecture handouts or other references provided by the lecturers or tutors.

We strongly hope that this module can be very useful in helping the students in solving the problem of urine incontinence and fall; able to confirm the dignosis and becoming well knowledgable for the treatment and prevention. Makassar , February 2011

Creative Team, Geriatry & Growth Development System

STUDENTS TASKS
1. After reading the above scenarios thoroughly, the students must discuss the cases in a leader-led group discussion. Both the leader and the secretary are chosen by the students themselves. Conducting a self study by providing data/information that will support the discussion Conducting a self-coached group discussion (without tutor) Consulting the problems revealed during the PBL to the experts for a better understanding Attending provided experts lecture for unsolved problems

2. 3. 4. 5.

PROBLEM SOLVING PROCESS

In a leader-led group discussion, the students are expected to solve the problems in the scenarios by conducting these following 7 jumps of problem solving process: 1. Clarifying the un-clear terms stated in the scenario, then defining the keywords/key statement(s) 2. Identifying the basic problem of the scenario, by creating some leading important questions 3. Analizing the problems by answering the above questions 4. Classifying the answers 5. Developing study objectives that must be achieved by the students during the case discussion 6. Looking for other supporting information related to the above cases 7. Reporting the result of discussion and synthesizing the other identified information Important Notes: Step 1 to 5 are conducted during the first coached-tutorial with the tutor Step 6 is a self study; performed out of the class either by a group discussion or by student solely, which will then be discussed together in an un-coached group Step 7 is conducted during the second coached-tutorial with the tutor

ACTIVITIES SCHEDULE
1. First meeting in a general class lecture; the lecture delivers a one way communication of lecturing followed with asking question session Objective: explaining the module and how to complete the provided tasks developing several discussion groups. During this first meeting, the modules will also be distributed to the students. Second meeting: self-study. Objectives: choosing a group leader and secretary

2.

brain storming for step 1 to 3 distributing tasks for members of the group 3. Third meeting: a leader-led group discussion, facilitated by a tutor. Objective: to report the self-study result and accomplish the PBL process to the fifth step Self-study, either together with other students in a group discussion or solely. Objective: Collecting other new necessary information Fourth meeting: a leader-led group discussion, facilitated by a tutor. Objective: reporting the last discussion result as well as for synthesizing the recently identified information Fifth meeting (last one): conducted in a general class, applying a panel discussion form, in which students report the final results of each groups discussion, and clarifying things that remain unsolved by the groups.

4.

5.

6.

TIME-TABLE
PERTEMUAN I
1st Meeting Explanatio n

II
2nd Meeting; self study (Brain Storming)

III
1st Tutorial Collecting information ,analyzing and synthesizin g data

IV
Self Study

V
Lecture, Consultatio n

VI
2ndTutorial (Reporting and discussing)

VII
Last Meeting (Reporting)

Practica l Work, CSL

STUDY STRATEGIES
1. 2. 3. 4. 5. 6. A leader-led group discussion, facilitated by a tutor A leader-led group discussion, without a tutor Experts consultation Experts lecture in a general class Self-study activities in the library with books, magazines, slides, tape recorder, video or the internet. Conducting practical work of Anatomy, Physiology, Biochemistry, Histology, Pathology Anatomy, Microbiology, Clinical Pathology and Nutrition

OTHER SOURCES OF INFORMATION AND REFERENCE LIST

A. Hand outs and Journals Anatomy Histology Biochemistry Pathology Anatomy Microbiology 1. Baron, JD; Peterson, LR; Finegold, SM: Bailey & Scotts Diagnostic Microbioloy, 9th edition, Mosby, Sydney, 1994. 2. Brooks, GF; Butel, JS; Morse, SA: Jawezt, Melnick, & Adelbergs Medical Microbiology, 23rd Edition, International Edition, McGraw-Hill, Kuala Lumpur, 2004. 3. Cohen, J., et all: Infectious Diseases, Volume 1, 2nd Edition, Mosby, Sydney, 2004. 4. Ryan, KJ; Ray CG: Sherris Medical Microbiology, an Introduction to Infectious Diseases, 4th Edition, McGraw-Hill, Singapore, 2004. 5. Joklik, WK; Willett, HP; Amos, DB; Wilfret, CM: Zinsser Microbiology, 20th Edition, Appleton & Lange, Connecticut, 1992. 6. Virella, G.: Microbiology and Infectious Diseases, 3rd Edition, Wlliams & Wilkins, Tokyo, 1997. Geriatry 1. Brocklehurst JC, Allen SC. Urinary Incontinence. Geriatric Medicine for Student. 3rd ed. Churchill Livingstone; 1987. 73-91. 2. Boedhi-Darmojo R. Teori Proses Menua. Dalam : Buku Ajar Geriatri. Ed 2, Edit oleh R.Boedhi-Darmojo & Hadi Martono. Balai Penerbit Fakultas Kedokteran Universitas Indonesia, 2000; 3-12. 3. Cordts GA. Urinary Incontinence. In: Forciea MA, et al. Editors. Geriatric Secrets. Philadelphia: Hanley & Belfus Inc; 1996. 185-93. 4. Fonda D. Management of The Incontinent Elderly Patient. In: Update in Geriatric Medicine 5. Kane RL, Ouslander JG, Abrass IB. Essential of Clinical Geriatrics. New York. McGraw-Hill; 1994. 145-96. 6. Konety B, Tewari Pasien, Narayan P : Urinary Incontinence. In: Lonergan ET. Editor. Geriatrics. Stamford Conecticut: Appleton & Lange. 1996. 489-96. 7. Lapitan MCM. The Role of The Pelvic Floor in Urinary Incontonence and Other Urological Conditions. Medical Progress. 1999; 26 : 27-32. 8. Lim PHC. Overactive Bladder. Medical Progress. 2000; 27: 17-23. 9. Setiati S. Pedoman Pelaksanaan Inkontinensia Urin Pada Pasien Geriatri. Dalam: Pedoman Pengelolaan Kesehatan Pasien Geriatri. Editor Soejono CH, Setiati S, Wiwie MSN, Silaswati S. Pusat Informasi da Penerbitan Bagian Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia. 2000: 85102. 10.Pranarka K. Inkontinensia. Dalam : Buku Ajar Geriatri. Ed 2, Edit oleh R.Boedhi-Darmojo & Hadi Martono. Balai Penerbit Fakultas Kedokteran Universitas Indonesia. 2000; 177-188.

Paediatrics 1. Soetjihningsih. Tumbuh kembang anak. Ranuh G Ed. Jakarta :EGC, 1995. 2. Sularyo TS. Pertumbuhan linier anak dan upaya pemantauanya dengan minat perawakan pendek/terlalu pendek. Dalam: Rukman Y, Batubara Yose, Tridjaja B, Eds. Masalah penyimpangan pertumnbuhan somatik pada anak dan remaja. PKB ilmu kesehatan anak XXVIII, Jakarta 1993. 3. Tanuwidjaya S. Konsep tumbuh dan kembang. Dalam : Narendra MB, Sularyo TS, Soetjiningsih, Suyitno H, Ranuh IG. Eds. Tumbuh kembang anak dan remaja. Jakarta. Sagung Seto, 2002,1-13. 4. Needlmn RD. Growth and development. Dalam : Behrman RE, Kliegman RM, Jenson HB, Eds. Nelson textbook pediatrics 17 th, Philadelphia,WB Saunders 2004:23-65 5. Pedoman pelaksanaan stimulasi, deteksi dan intervensi dini Tumbuh Kembang Anak di tingkat pelayanan dasar. Depkes RI 2005 6. Tumbuh kembang-pedsos. Dalam : Pusponegoro HD, Hadinegoro SR, Firmanda D, Tridjaja B, Eds.Standar Pelayanan Medis kesehatan anak Edisi1: IDAI; 2004. 367-369. 7. Levine DA. Growth and development. Dalam : Behrman RE, Kliegman RM, Jenson HB, Eds. Nelson textbook pediatrics 5 th, Philadelphia: Saunders 2004;23-65 8. Soedjatmiko. Stimulasi dini untuk bayi dan balita. Dalam : Pulungan AB, Hendarto A, Hegar B, Oswari H. Eds. Continuing Profesional Development Nutrition Growth-development. IDAI Jaya 2006, 27-46. B. Lecture Handout C. Other source : VCD, Film, Internet, Slide, Tape D. Lecturers
No. 01. 02. 03. 04. 05. 06. 07. 08. 09. 10. 11. NAMA DOSEN Prof.Dr.dr.Edu S.Tehupeiory, SpPD-KR Prof.dr.H.Junus Alkatiri, SpPD-KKV, SpJP(K), FIHA Prof.dr. H.A.M. Akil, SpPD-KGEH Prof.dr.H.Achmad M.P, SpB,SpBU(K) Prof.dr.H.Harsinen Sanusi, SpPD-KEMD Prof.Dr.dr.H.Syakib Bakri, SpPD-KGH Prof.dr. Piter Kabo, PhD, SpFK, SpJP Dr. H.M.Junus Patau, SpP, SpPD-KP Dr. H.A.Fachruddin Benyamin, SpPD-KHOM dr. H.Wasis Udaya, SpPD Dr.dr. Hj.Nurpudji Astuti Taslim, MS BAGIAN Penyakit Dalam / Reumatologi Kardiologi / Penakit Dalam Penyakit Dalam / Gastroenterohepatologi Bedah Urologi Penyakit Dalam / EndokrinMetabolik Penyakit Dalam / GinjalHipertensi Farmakologi dan Kardiologi Penyakit Dalam / Pulmonologi Penyakit Dalam / HematologiOnkologi Penyakit Dalam / Geriatri Gizi Klinik 0811440252 / 081342945932 08159912601 / 5766036 0811443856 HP / FLEXI 081524187006 / 5020948 08124151234 / 0816250816

12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.

Dr.dr. A.Wardihan Sinrang, MS, SpAnd Prof. dr. Rosdiana Natsir, PhD dr. H.Tahir Abdullah, MSc dr.H.A.Jayalangkara Tanra, PhD, SpKJ dr. Asmaun Nadjamuddin, SpRM dr. Muhammad Akbar, PhD, SpS dr. A. D a r w i s, SpRad dr. Henry Yurianto, SpOT dr. Hj.Habibah S. Muhiddin, SpM dr. H. H a m z a h , SpM dr. Hj. Farida Tabri, SpKK

Fisiologi Biokimia IKM / IKP Psikiatri Rehabilitasi Medik Neurologi Radiologi Bedah Orthopedi Ilmu Penyakit Mata Ilmu Penyakit Mata Ilmu Penyakit Kulit & Kelamin Ilmu Kesehatan Anak Ilmu Kesehatan Anak Ilmu Kesehatan Anak Ilmu Kesehatan Anak 081342585728 0811415252

Prof. Dr.dr. Syarifuddin Rauf, SpA(K) dr. J. S. Lisal, SpA(K) dr. Ny. Djuahariah A. Madjid, SpA(K) dr. Martira Maddeppungeng, SpA

0811411109 0811418053 0811446616 081342903666

E. REFERENCES
Boedhi-Darmojo R. Teori Proses Menua. Dalam : Buku Ajar Geriatri. Ed 2, Edit oleh R.Boedhi-Darmojo & Hadi Martono. Balai Penerbit Fakultas Kedokteran Universitas Indonesia, 2000; 3-12. Campbell JA, Borrie MJ, Spears GF. Risk Factor for Falls in A Community Based Prospective Study of People 70 years and Older. J Gerontology Medical Sciences, 44:M112-117, 1987. Isbagio H. Perbedaan antara osteoporosis dengan gangguan muskuloskeletal lainnya. Dalam : Naskah Lengkap Simposium Diagnostik dan Penatalaksanaan Terpadu Osteoporosis. FKUI, Jakarta, 1994. Kane RL, Ouslander JG, Abrass IB. Instability and Falls. In : Kane RL ed; Essentials of Clinical Geriatrics. 3rd ed. Mc Graww-Hill Inc, New York, 1994; 197-219. Kane RL, Ouslander JG, Abrass IB. Clinical Implications of The Aging Process. In : Kane RL, Ouslander JG, Abrass IB (eds). Essentials of Clinical Geriatrics. New York. Mc GrawHill, 1994 ; 3-17. Setiati S. Proses Menua dan Implikasi Kliniknya. Dalam : Pedoman Pengelolaan Kesehatan Pasien Geriatri. Ed 1. Edit : Soejono CH, Setiati S, Wiwie MS, Silaswati S. Pusat Informasi dan Penerbitan Bagian Ilmu Penyakit Dalam FKUI, 2000 ; 6-15.

Soejono CH. Instabilitas dan Jatuh. Dalam : Pedoman Pengelolaan Kesehatan Pasien Geriatri. Ed 1. Edit : Soejono CH, Setiati S, Wiwie MS, Silaswati S. Pusat Informasi dan Penerbitan Bagian Ilmu Penyakit Dalam FKUI, 2000 ; 109-114. Tinetti MR. Falls. In : Hazzard WR, Andres R, Bierman EL, Blass JP ed ; Principles of Geriatric Medicine and Gerontology, 2nd ed. Mc Graww-Hill Inc, New York, 1992; 1192-1199. Van der Cammen TJM, Rai GS, Extonsmith AN. Instability and Falls. In : Manual of Geriatrics Care. Churchill-Livingstone, Edinburg, 1991. Williams ME. Approach to Managing the Elderly Patient. In : Hazzard WR, Bierman EL, Blass JP, et al (eds). Principles of Geriatric Medicine and Gerotology. New York. Mc GrawHill Inc, 1999 ; 249-253.

GERIATRY & GROWTH DEVELOPMENT SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY

STUDENTS MODULE FALLS & URINE INCONTINENTIA

Given to 6th Semester Medical Students Of Hasanuddin University

Created By dr. Femi Syahriani, SpPD. dr. Wasis Udaya, SpPD.

GERIATRY SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY 2011

MODULE FALLS
STUDY GOALS
After learning the module, the students are expected to have the ability in explaining the principal concept of knowledge related to the process that might develop fall among the elderly, as well as the possible risk factors both intrinsic and extrinsic factors.

CASES
SCENARIO I

A 73 year old woman was hospitalized due to pain at her right hip, leading to pain sensation whenever she walked. She has been having the problem since 3 days ago, it started when she fell in sitting position in the toilet. She had the back bending posture since last year. She was in medication for diabetes, hypertention, heart disease and rheumatic. Four years ago, she had stroke attack. .
SCENARIO II

A 69 year old man came to a hospital because he can not move both of his legs. Prior to this, he was sliped and landed on a sitting position. He claimed that he did not see the spilled water ahead of him. It has been a week since he has been coughing and difficult in breathing. He lost his appetite, but having no fever. All this time he was in medication for diabetes and hypertention.

MODULE

URINE INCONTINENTIA

STUDY GOALS
After learning the module, the students are expected to have the ability in in solving the problem of urine incontinensia; able to confirm the dignosis and become well knowledgable for the treatment and prevention.

CASES
Scenario 1 A 79 year old man was taken to PUSKESMAS with frequent urinate but less in quantity. Eventough the prosess took a long time, most of the time he felt unsatisfied. This condition started 7 days ago. He also complained about knee pain that he had been having for some times. According to the family, the man was always in a bad temper, easy forgetting lots of things which he just did. He was in medication for diabetes, hypertention, heart

disease and rheumatic for about 7 years now. Three years ago, he had stroke attack.

Scenario 2 A 68 year old woman was taken to PUSKESMAS by her family. According to the family, she frequently went to the toilet for peeing. She did not complain of any pain during urinate. It had been a week since she started to cough and bit hard in cathing up her breath, her appetite lost significantly, no fever. She had diabetes and hypertention, and she was in medication for both.

GERIATRY & GROWTH DEVELOPMENT SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY

STUDENTS MODULE
IMPAIRMENT IN CHILDREN GROWTH & DEVELOPMENT

Given to 6th Semester Medical Students Of Hasanuddin University

Created By : Prof.dr.Ny Djauhariah A Madjid SpA(K) dr.Martira M Maddeppungeng SpA

GERIATRY SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY 2011

INTRODUCTION

These modules of Impairment in Children Growth and Development & Energy Protein Malnutrition are designed for the sixth semester students of UNHAS Medical Faculty, as part of the Geriatry and Growth Development System Curriculum.

By using the module of Impairment in Children Growth and Development, the students are expected to comprehend the children growth and develoment process from the newborn until adoloscent, factors thet intervene the process, as well as understanding the importance of monitoring the process for early impairment detection.

PBL process includes activities like tutorial meetings, self study for information gathering from the experts, text books, journals in the library or through the internet, writing and presenting final report as the result of the PBL discussion process.

We strongly hope that through this PBL the students will be more active to search for solutions to overcome the challenges presented in the scenarios that are most likely be found in the community.

Makassar , February 2011

Creative Team, Geriatry & Growth Development System

MODULE

IMPAIRMENT IN CHILDREN GROWTH AND DEVELOPMENT

GENERAL INSTRUCTIONAL OBJECTIVES After learning the module, the students are expected to have the ability in explaining the growth and development process, defining normal children growth and development, defining children nutritional status, planning children vaccination and identifying any impairment in growth and development in children.

SCENARIO : A, a boy was taken to Puskesmas in Desember 5th 2009 due to overnight fever. He born in February the 25th, 2009; supported by a midwife, hardly breathing when he was first delivered, with weak muscle tonus, birth weight (BW) 3000 grams, birth length (BL) 49 cm, head circumference (HC) 35 cm. The last 2 months consequtive weighin records: 6100 grams dan 6300 grams, with HC 44 cms. For daily meal the baby was fed with rice and vegetables, tofu, tempe, and sometimes egg. Starting from the age of 3 months, he consumed formula milk, bananas and baby porridge because he cried most of the time. He got BCG immunization when he was 2 months old; 4 times polio vaccine; B Hepatitis vaccine twice, in the age of 40 days and 3 months; DPT when he was 2 and 6 months old. The baby was able to crawl, but not yet sit and stand by him self. Sometimes mumbled, not able to hold jingling toys with his hands. He responded to sound, and able to show the direction of the sound source, can not feed him self with biscuits, and do not know how to play peek-a-boo. His mother was elementary school graduate only. Toys available at home: jingling toys, dolls, a three wheel bicycle. The mother never talked much.

MODULE MALNUTRISI ENERGI PROTEIN

GENERAL INSTRUCTIONAL OBJECTIVES

After learning the module, the students are expected to have the ability in explaining the definition, etiology, pathogenesis, clinical features, required laboratory tests and other supporting examinations, diagnosis and complication, other accompanying

diseases/conditions, management, and prevention of Malnutrition condition in general and Protein and Energy Malnutrition condition in particular.

SCENARIO:

A 1 year old and 11 month boy was hospitalized due to fever and recurrent cough during the last 6 months, and now showing shortness of breathing. He also showed less apetite, and swelling of lower legs and stomach for the last 1 month. He had frequent diarrhea, sometimes accompanied with bloody and mucoid stool. The parents were economically struggle. Contact history with TB patient was not clear.

Physical examination findings: The child looked very sick with very bad nutritional status, apthy, body weight 8.1 kgs, body height 76 cms, looked dyspnoeic, nose tip breathing, tachypnoe, cyanosis. Lung: wet ronchy, but not clear; Heart: normal; face, palm and feet looked pale; Liver: 3 cms below ribs curve; Spleen: S1, edema dorsum pedis, pretibial and upper legs, ascites. Dehydration score: 10.