Skenario D blok 24 tahun 2018

A new born baby was delievered at private clinic, assisted by midwife. He was delivered
from a 30 years old woman, primigravida. Mrs. Anita, the baby’s mother has premature
ruptured of membrane 5 days ago. The liquor was thick, smelly, and greenish. She also had
fever since two days before delivery. The pregnancy was full term. The baby was not cried
spontaneously after birth. The midwife cleared the baby’s airway using manual suction and
stimulate the baby by patting his feet, and then he started to cry weakly 5 minutes later. After
2 hours observation the midwife saw the baby still breathing uneasily and had grunting. The
baby was refered to Moh Hoesin Hospital

Physical examination revealed body weight was 3500 grams. Body lenght 50 cms, head
circumference 34 cms. He looked hypoactive, tachypnoe, RR 86x/mitute. There was chest
indrawing, grunting could be heard using stethoscope, breathing sound was normal, satiration
80% using nasal oxygen. Sucking reflex was weak. HR 168x/minute. Abdomen was tender
with normal bowel sound. There were not meconeum staining at umbilical cord and skin.

Instruction

As GP what will you do to treat the baby?

I. Klarifikasi istilah
1. Primigravida: kehamilan untuk pertama kalinya.
2. Premature rupture membrane: kondisi membran kantung ketuban pecah sebelum
terjadinya proses melahirkan, yang membuat ketuban terbuka dan menyebabkan
cairan ketuban menyembur keluar atau bocor secara perlahan.
3. Full term pregnancy: bayi yang lahir pada umur kelahiran 37-42 minggu.
4. Hypoactive: penurunan abnormal aktivitas motorik dan kognitif yang ditandai
dengan melambatnya pemikiran, pembicaraan, dan pergerakan.
5. Chest indrawing: tarikan dinding dada bagian bawah ke dalam terjadi ketika
dinding dada bagian bawah ditarik saat menarik nafas.
6. Mekonium: bahan berlendir yang berwarna hijau tua yang berada di dalam usus
bayi cukup bulan.
II. Identifikasi masalah
 1. A new born baby was delievered at private clinic, assisted by midwife. He was
delivered from a 30 years old woman, primigravida. The pregnancy was full term.
The baby was not cried spontaneously after birth.
2. Mrs. Anita, the baby’s mother has premature ruptured of membrane 5 days ago.
The liquor was thick, smelly, and greenish. She also had fever since two days
before delivery .
3. The midwife cleared the baby’s airway using manual suction and stimulate the
baby by patting his feet, and then he started to cry weakly 5 minutes later. After 2
hours observation the midwife saw the baby still breathing uneasily and had
grunting. The baby was refered to Moh Hoesin Hospital
4. Pemeriksaan fisik
III. Analisis masalah
1. A new born baby was delievered at private clinic, assisted by midwife. He was
delivered from a 30 years old woman, primigravida. The pregnancy was full term.
The baby was not cried spontaneously after birth.
a. Bagaimana hubungan usia ibu dan status kelahiran dengan keluhan bayi?
b. Apa makna klinis dari bayi tidak meangis spontan setelah lahir?
c. Apa etiologi dan bagaimana mekanisme bayi tidak menagnis spontan terkait
kasus?
d. Apa tata laksana awal yang dapat dilakukan pada bayi yang tidak menangis
secara spontan?
e. Apa dampak yang dapat terjadi pada kejadian diatas jika tidak ditata laksana
segera?
2. Mrs. Anita, the baby’s mother has premature ruptured of membrane 5 days ago.
The liquor was thick, smelly, and greenish. She also had fever since two days
before delivery.
a. Apa makna klinis dari ketuban pecah dini terkait kasus?
b. Apa makna klinis dari air ketuban kental, berbau, dan berwarna hijau?
c. Apa penyebab dan mekanisme dari air ketuban kental, berbau, dan berwarna
hijau?
d. Apa perbedaan dari air ketuban normal dengan air ketuban pada kasus
(patologis)?
e. Apa makna klinis dari ibu mengalami demam sejak 2 hari sebelum persalinan?
 f. Apakah ada hubungan antara riwayat ibu demam dengan kondisi bayi (tidak
menangis spontan)?
g. Apa saja penyebab terjadinya ketuban pecah dini (secara umum)?
h. Apa saja dampak yang terjadi dari ketuban pecah dini terhadap ibu dan bayi?
i. Bagaimana tata laksana awal dari ketuban pecah dini terhadap ibu dan bayi?
3. The midwife cleared the baby’s airway using manual suction and stimulate the
baby by patting his feet, and then he started to cry weakly 5 minutes later. After 2
hours observation the midwife saw the baby still breathing uneasily and had
grunting. The baby was refered to Moh Hoesin Hospital.
a. Apa indikasi dari tindakan yang dilakukan oleh bidan?
b. Apa tata laksana lain yang dapat dilakukan selain dari tindakan pada kasus?
c. Apa makna klinis dari keadaan bayi setelah ditata laksana?
d. Apa yang perlu dimonitoring dari keadaan bayi dan indikasi perbaikan setelah
dilakukan tindakan tersebut?
e. Apa indikasi bayi tersebut dirujuk ke Moh Husein hospital?
4. Pemeriksaan fisik
Physical examination revealed body weight was 3500 grams. Body lenght 50 cms,
head circumference 34 cms. He looked hypoactive, tachypnoe, RR 86x/mitute.
There was chest indrawing, grunting could be heard using stethoscope,
a. Bagaimana interpretasi dari hasil pemeriksaan fisik?
b. Bagimana mekanisme abnormal dari hasil pemeriksaan fisik?
5. Breathing sound was normal, satiration 80% using nasal oxygen. Sucking reflex
was weak. HR 168x/minute. Abdomen was tender with normal bowel sound.
There were not meconeum staining at umbilical cord and skin.
a. Bagaimana interpretasi dari hasil pemeriksaan fisik?
b. Bagimana mekanisme abnormal dari hasil pemeriksaan fisik?
c. Bagaimana gambaran dari mekoneum terkait kasus?
d. Pemeriksaan apa saja yang dapat dilakukan terkait kasus?

Hipotesis: bayi baru lahir menderita sepsis neonatorum dengan distress pernapasan

a. DD
b. How to diagnose
c. WD
d. Definisi
 e. Epidemiologi
f. Etiologi
g. Faktor resiko
h. Patofisiologi atau patogenesis
i. Klasifikasi
j. Manifestasi klinis
k. Tata laksana
l. Pemeriksaan penunjang
m. Komplikasi
n. Pencegahan
o. Prognosis
p. SKDI
IV. Learning issues
1. Bronkopneumonia
2. Sepsis neonatorum
3.