SCENARIO D BLOK 22 FK UNSRI 2019

A male newborn are delivered at priclinc, assisted by midwife. He was delivered form a 36 years
old woman, primigravida. Mrs. SIti, the baby’s mother had premature ruptured of membrane since
4 days ago. The liquor was thick, smelly and greenish. She had fever since one day before delivery.
She also had history of hypertension during the last trimester of pregnancy. The pregnancy was
full term, 39 weeks. The baby was not cried spontaneously after birth. The widwife said Apgar
score 1 for 1st minute and 2 for 5 th minutes and 5 at 10th minute. The baby had difficulty while
breathing, and had grunting. The midwife then referred him to Moh Hoesin Hospital.

Physical examination revealed body weight was 2300 g. Body length 48 cms, head circumference
34cms. His temperature was 36 C. He looked hypoactive and tachypnoe, respiratory rate 72 breaths
perminute, there were chest indrawing, gruniting could be heard using stethoscope, breathing
sound was normal, he still looked cyanotic even after been giving nasal oxygen. Sucking reflex
was weak. Heart are was 14 beats per minute. Abdomen was tender with normal bowel sound.
There were meconeum staning at umbilical cord and skin. Other examination within normal

I. Klarifikasi Istilah

a. Premature rupture of membrane : pecahnya ketuban selama kehamilan sebelum

usia gestasi mencapai 37 minggu

b. APGAR SCORE : suatu metode sederhana yang digunakan untuk menila keadaan
umum bayi sesaat setelah kelahiran

c. Grunting : bunyi pernapasan abnormal saat ekspirasi yang menunjukkan bahwa

glottis telah tertutup aliran udara dari paru, untuk mencegah kolaps paru. Terdengar
pada bayi premature akibat sindrom gawat nafas.

d. Hipoaktif : penurunan abnormal aktivitas motorik dan kognitif ditandai dengan

melambatnya pemikiran, pembicaraan dan pergerakan

e. Manual suction : tindakan penghisapan yang bertujuan untuk mempertahankan

jalan nafas shingga memungkinkan terjadinya proses pertukaran gas yang adekuat
dengan cara mengeluarkan secret dari jalan nafas pada pasien yang tidak dapat
mengeluarkannya sendiri

f. Meconium : bahan berlendir yang berwarna hijau tua di dalam usus bayi cukup
bulan

g. Sucking reflex : gerakan bibir menghisap yang timbul karena menyentuhnya bibir
atau kulit di sekitar mulut
 h. Chest in drawing : gerakanan masuk ke dalam dinding dada bagian bawah ketika
anak bernafas, biasanya tanda respiratory distress

i. Umbilical cord : jaringan pengikat yang menghubungkan plasenta dan fetus (janin)
untuk menjaga viabilitas (kelangsungan hidup) dan memfasilitasi embrio dan janin

j. Nasal oxygen : alat yang diguanakan unruk mengantarkan oksigen supplemental

atau menambah airflow untuk pasien atau orang yana membutuhkan bantuan
respiratory

k. Cyanotic : perubahan warna kulit dan membrane mukosa menjadi kebiruan akibat
konsentrasi hemoglobin tereduksi yang berlebihan dalam darah

l. Liquor : suatu cairan tubuh (amniotic fluid)

II. Identifikasi Masalah

1. A male newborn are delivered at private clinic, assisted by midwife. He was

delivered form a 36 years old woman, primigravida. The baby was not cried
spontaneously after birth. The widwife said Apgar score 1 for 1st minute and 2 for
5th minutes and 5 at 10th minute. The baby had difficulty while breathing, and had
grunting. The midwife then referred him to Moh Hoesin Hospital. VVV

2. Mrs. Siti, the baby’s mother had premature ruptured of membrane since 4 days ago.
The liquor was thick, smelly and greenish. She had fever since one day before
delivery. VV

3. She also had history of hypertension during the last trimester of pregnancy. The
pregnancy was full term, 39 weeks. VV

4. Physical examination revealed body weight was 2300 g. Body length 48 cms, head
circumference 34cms. His temperature was 36 C. He looked hypoactive and
tachypnoe, respiratory rate 72 breaths perminute, there were chest indrawing,
gruniting could be heard using stethoscope, breathing sound was normal, he still
looked cyanotic even after been giving nasal oxygen. Sucking reflex was weak.
Heart are was 14 beats per minute. Abdomen was tender with normal bowel sound.
There were meconeum staning at umbilical cord and skin. Other examination
within normal. V

III. Analisis Masalah

1. A male newborn are delivered at private clinic, assisted by midwife. He was
delivered form a 36 years old woman, primigravida. The baby was not cried
spontaneously after birth. The widwife said Apgar score 1 for 1st minute and 2 for
5th minutes and 5 at 10th minute. The baby had difficulty while breathing, and had
grunting. The midwife then referred him to Moh Hoesin Hospital. VVV

a. Apa hubungan usia, riwayat kehamilan ibu terhadap keluhan pada kasus?
tia,arindi

b. Bagaiamana anatomi dan fisiologi organ yang terganggu pada kasus? tj, elsa

c. Bagaimana cara menghitung score APGAR? wella, mutia

d. Apa interpretasi APGAR score pada kasus? fira,soni

e. Apa kemungkinan penyebab bayi lahir tidak menangis spontan? ririn, rara

f. Apa penyebab bayi kesulitan untuk bernafas dan merintih? tia, arindi

g. Bagaiamana tatalaksana awal pada bayi? tj, elsa

h. Bagaimana mekanisme gejala yang terdapat pada kasus? wella, mutia

2. Mrs. Siti, the baby’s mother had premature ruptured of membrane since 4 days ago.
The liquor was thick, smelly and greenish. She had fever since one day before
delivery. VV

a. Apa kemungkinan penyebab KPD? fira, soni

b. Apa komplikasi yang dapat timbul pada bayi dengan ibu yang mengalami KPD?
ririn, rara

c. Bagaiamana karakteristik cairan amnion yang normal? tia, rara

d. Apa makna kalimat ”The liquor was thick, smelly and greenish. She had fever
since one day before delivery.”? arindi,ririn

e. Bagaiamana dampak KPD pada proses persalinan? tj, soni

f. Bagaimana kriteria KPD?elsa, fira

g. Bagaimana tatalaksana KPD? wella, mutia

3. She also had history of hypertension during the last trimester of pregnancy. The
pregnancy was full term, 39 weeks. VV

a. Apa hubungan riwayat hipertensi dengan kelainan pada bayi dan ibu? tia, elsa

b. Bagaimana dampak hipertensi pada bayi dan ibu? arindi, wella

c. Apa yang dapat menyebabkan respiratory distress pada bayi cukup bulan? tj,
mutia

4. Physical examination revealed body weight was 2300 g. Body length 48 cms, head
circumference 34cms. His temperature was 36 C. He looked hypoactive and
tachypnoe, respiratory rate 72 breaths perminute, there were chest indrawing,
gruniting could be heard using stethoscope, breathing sound was normal, he still
looked cyanotic even after been giving nasal oxygen. Sucking reflex was weak.
Heart are was 14 beats per minute. Abdomen was tender with normal bowel sound.
There were meconeum staning at umbilical cord and skin. Other examination
within normal. V

a. Bagaimana interpretasi pemeriksaan fisik pada kasus? fira, soni

b. Bagaimana mekanisme abnormal pemeriksaan fisik pada kasus? ririn, rara

c. Bagaimana derajat keparahan respiratory disteess? tia, arindi

5. Hipotesis : Seorang bayi laki-laki baru lahir mengalami respiratory distress.

a. Apa diagnosis banding pada kasus?

b. Algoritma penegakkan diagnosis

c. Diagnosis kerja

d. Definisi
e. Etiologi
f. Epidemiologi
g. Faktor Risiko
h. Manifestasi Klinis
i. Patofisiologi
j. Patogenesis
k. Algoritma Diagnosis
l. Pemeriksaan penunjang
 m. Tatalaksana ( farmako dan non farmako )
n. Edukasi pencegahan
o. Komplikasi
p. Prognosis ( beserta angka mortalitas,morbiditas,survival)
q. SKDI
r. Indikasi Rujukan

Learning issues :
1. Anatomi dan fisiologi ririn, rara, soni
2. KPD arindi, tj, elsa, wella
3. Chorioamnionitis mutia, fira, tia
4. Respiratory distress (meconium aspiration syndrome)
a. Apa diagnosis banding pada kasus? tj, rara

b. Algoritma penegakkan diagnosis elsa, tia

c. Diagnosis kerja

d. Definisi mutia, arindi

e. Etiologi fira, tj
f. Epidemiologi wella, mutia
g. Faktor Risiko soni, fira
h. Manifestasi Klinis ririn, soni
i. Patofisiologi rara, ririn
j. Patogenesis tia, rara
k. Algoritma Diagnosis arindi, tia
l. Pemeriksaan penunjang tj, arindi
m. Tatalaksana ( farmako dan non farmako ) elsa, tj
n. Edukasi pencegahan wella, elsa
o. Komplikasi mutia, wella
p. Prognosis ( beserta angka mortalitas,morbiditas,survival) fira, mutia
q. SKDI soni
r. Indikasi Rujukan ririn, fira