RESPONSI
ASFIKSIA NEONATORUM
Pembimbing: Dr. dr. I Made Kardana, Sp.A (K)
Disusun oleh: Sintia Sugiarta Rahmasari
(1302006153) (1302006153)
I Made Aryasa Mugi Raharja
(1302006253) (1302006253)
Putu Bagus Redika Janasuta
(1202006146) (1202006146)
DALAM RANGKA MENGIKUTI KEPANITERAAN KLINIK MADYA
BAGIAN/SMF ILMU KESEHATAN ANAK FK UNUD/RSUP SANGLAH DENPASAR 2017
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KATA PENGANTAR
Puji syukur penulis panjatkan kehadapan Tuhan Yang Maha Esa, karena atas berkah dan rahmat-Nyalah pada akhirnya penulis dapat menyelesaikan responsi ini yang mengangkat kasus “ Asfiksia Neonatorum” Neonatorum ” tepat pada waktunya. Responsi ini disusun dalam rangka mengikuti Kepaniteraan Klinik Madya (KKM) di Bagian/SMF Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar. Dalam penyusunan dan penulisan responsi ini, penulis banyak mendapatkan bimbingan dan bantuan, baik berupa informasi maupun bimbingan moral. Untuk itu, pada kesempatan ini penulis penulis ingin menyampaikan menyampaikan terimakasih kepada:
1.
dr. Bagus Ngurah Putu Arhana, Sp.A(K) selaku kepala Bagian/SMF Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar.
2.
dr. I Wayan Dharma Artana, Sp.A(K) selaku koordinator pendidikan di Bagian/SMF Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar.
3.
Dr. dr. I Made Kardana, Sp.A (K) selaku pembimbing responsi di Bagian/SMF Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar.
4.
Dokter-dokter Spesialis Anak di Bagian/SMF Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar.
5.
dr. Kirana Dyah Larasati Budhiarta, selaku dokter Residen pembimbing di Bagian/SMF Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar.
6.
Rekan-rekan sejawat (Dokter Residen dan Dokter Muda) di Bagian/SMF Ilmu Kesehatan Anak FK UNUD/RSUP Sanglah Denpasar.
7.
Semua pihak lain yang telah membantu dalam penyusunan laporan responsi ini. Penulis menyadari bahwa responsi ini masih masi h jauh dari kesempurnaan. Oleh
karena itu, kritik dan saran yang bersifat membangun dari semua pihak sangat diharapkan dalam rangka penyempurnaan laporan ini. Penulis mengharapkan semoga laporan ini dapat memberikan manfaat di bidang ilmu pengetahuan kedokteran. Denpasar, Juli 2017
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DAFTAR ISI
HALAMAN JUDUL ................................................. ........................................................................ ..................................... ..............
i
KATA PENGANTAR ..................................................... ............................................................................ ............................... ........
ii
DAFTAR ISI ............... .. .......................... ........................... ......................... ........................ .......................... ........................... .................... ......
iii
BAB I
BAB II
PENDAHULUAN ................................................. ........................................................................ ......................... ..
1
1.1
1
Latar Belakang........................................... Belakang................................................................... ............................... .......
TINJAUAN PUSTAKA ................................................................
2
2.1
Definisi .....................................................................................
2
2.2
Etiologi .....................................................................................
2
2.3
Patofisiologi ..............................................................................
4
2.4
Gambaran Klinis .................... .............................. .................... ................... .................. ................... ............. ...
4
2.5
Diagnosis ..................................................................................
4
2.6
Penatalaksanaan ................... ............................. ................... .................... ............................... ....................... ...
7
2.7
Komplikasi ............................................................................... 12
2.8
Prognosis .................................................................................. 14
BAB III LAPORAN KASUS .................................................... ....................................................................... ...................
3.1
Identitas Pasien ......................................................................... 15
3.2
Heteroanamesis (Ibu Kandung Pasien) .................................... ....................................
3.3
Pemeriksaan Fisik .................. ............................ ..................... ..................... .................... .................... .......... 17
3.4
Diagnosis Sementara ..................... ............................... ..................... ..................... ................... ............ ... 18
3.5
Pemeriksaan Penunjang .................... ............................... ..................... ............................. ................... 18
3.6
Diagnosis Kerja ................... ............................. .................... .................... .................... ................... ............. .... 22
3.7
Penatalaksanaan ................... ............................. ................... .................... ..................... .................... ............. ... 22
BAB IV PEMBAHASAN ................................................ ....................................................................... ............................. ......
BAB V
15
14
25
4.1
Anamesis ............................................ ................................................................... ..................................... ..............
25
4.2
Penatalaksanaan ................... ............................. ................... .................... ..................... .................... ............. ... 27
RINGKASAN .............................................. ...................................................................... ................................... ...........
28
DAFTAR PUSTAKA ................................................ ....................................................................... ..................................... ..............
30
FOTO PASIEN ............................................... ....................................................................... ............................................... .........................
31
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BAB I PENDAHULUAN
1.1.
Latar Belakang
Setiap tahun diperkirakan 4 juta bayi meninggal pada tahun pertama kehidupannya dan dua pertiganya mengalami meninggal dunia pada bulan pertama. Menurut hasil Survei Demografi dan Kesehatan Indonesia yang dilakukan pada tahun 2012, meunjukkan bahwa Angka Kematian Neonatal (AKN) di Indonesia sebesar 19 kematian/1000 kelahiran hidup. Penyebab utama dari kematian pada minggu pertama kehidupan adalah komplikasi kehamilan dan persalinan seperti asfikisia, sepsis, dan komplikasi berat lahir rendah. Menurut hasil riset kesehatan dasar pada tahun 2007, tiga penyebab kematian perinatal di Indonesia adalah Gangguan pernapasan (35,9%), prematuritas (32,4%) dan sepsis neonatum (12,0%).
1
Hipoksia janin yang menyebabkan asfiksia neonatorum terjadi karena gangguan pertukaran gas serta transport O 2 dari ibu ke janin sehingga terdapat gangguan dalam persediaan O 2 dan dalam menghilangkan CO 2. Perubahan pertukaran gas dan transport oksigen selama kehamilan dan persalinan akan mempengaruhi oksigenasi sel-sel tubuh yang selanjutnya dapat mengakibatkan gangguan fungsi sel. Gangguan ini dapat berlangsung secara menahun akibat dari kondisi ibu selama kehamilan, atau secara mendadak karena hal-hal yang diderita ibu dalam persalinan. Gangguan menahun dalam kehamilan dapat berupa gizi ibu yang buruk, penyakit menahun seperti anemia, hipertensi, penyakit jantung, dan lain-lain. Pada gangguan yang terakhir ini pengaruh terhadap janin disebabkan oleh gangguan oksigenasi serta kekurangan pemberian zat-zat makanan berhubungan dengan dengan gangguan fungsi plasenta.
1
Diperkiraan 1 juta anak yang bertahan setelah mengalami asfiksia saat lahir kini hidup dengan mordibitas jangka panjang seperti cerebral palsy, palsy, retardasi mental dan gangguan belajar. Asfiksia neonartum adalah kegawatan darurtan bayi yang baru lahir berupa depresi pernapasan yang berlanjut sehingga menimbulkan 1
berbagai komplikasi.
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BAB II TINJAUAN PUSTAKA
2.1.
Definisi
Asfiksia neonartum adalah suatu keadaan dimana bayi baru lahir tidak bernafas secara spontan, teratur dan adekuat. Asfiksia dapat bermanifestasi sebagai disfungsi multiorgan, kejang dan ensefalopati hipoksik-iskemik, serta asidosis metabolik. Bayi yang mengalami episode hipoksia-iskemi yang sangat signifikan saat lahir memiliki resiko disfungsi dari berbagai organ, dengan disfungsi otak pertimbangan utama. Beberapa sumber mendefinisikan asfiksia neonartum dengan berbeda:
2,3,4
8. Ikatan Dokter Anak Indonesia : Asfiksia neonartum adalah kegagalan napas secara spontan dan teratur pada saat lahir atau beberapa saat setelah lahir yang ditanai dengan hipoksemia, hiperkarbia, dan asidosis. 9. World Health Organization (WHO) : Asfiksia neonartum adalah kegagalan bernapas secara spontan dan teratur segera setelah lahir. 10. American 10. American Academy of Pediatrics dan American dan American College of obstetricians and Gynecologist : Seorang neonatus disebut mengalami asfiksia bila memenuhi kondisi sebagai berikut: Nilai APGAR menit kelima 0-3. Adanya asidosis pada pemeriksaan darah tali pusat (pH<7.0). Gangguan neurologis (misalnya kejang, hipotonia atau koma). Adanya gangguan sistem multiorgan (misalnya: gangguan kardiovaskular, gastrointestinal, hematologi, pulmoner, atau sistem renal. Atas dasar pengalaman klinis, Asfiksia Neonartum dapat dibagi dalam : 1. Vigorous baby: baby : score APGAR 7-10, dalam hal ini bayi dianggap sehat 2. Mild-moderate asphyxia (asfiksia sedang) : score APGAR 4-6 pada pemeriksaan fisis akan terlihat frekuensi jantung lebih dari 100x/menit, tonus otot kurang baik atau baik, sianosis, iritabilita s tidak ada
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3. Asfiksia berat : score APGAR 0-3. Pada pemeriksaan fisis ditemukan frekuensi jantung kurang dari 100x/menit, tonus otot buruk, sianosis berat dan kadang - kadang pucat, refleks irritabilitas tidak ada Asfiksia berat dengan henti jantung yaitu keadaan:
2
1. Bunyi jantung fetus menghilang tidak lebih dari 10 menit sebelum lahir lengkap. 2. Bayi jantung bayi menghilang post partum. 2.2.
Etiologi
Asfikisa neonartum akan terjadi jika terdapat gangguan pertukaran gas atau pengangkutan O 2 dari ibu ke janin. Gangguan ini dapat timbul pada massa kehamilan, persalinan atau segera setelah lahir. Hampir sebagaian besar asfiksia pada bayi baru lahir merupakan kelanjutan asfiksia janin, karena itu penilaian janin selama kehamilan dan persalinan. Memegang peran penting untuk keselamatan bayi atau kelangsungan hidup yang sempurna tanpa gejala sisa. Asfiksia neonatorum dapat disebabkan oleh beberapa faktor, yaitu
4,5
:
1. Faktor Neonatus Lanjutan asfiksia intra partum; aspirasi cairan amnion, darah, meconium, dan muntahan; imaturitas paru; kelainan jantung bawaan pada paru; anemia pada fetus; retardasi pertumbuhan intra uterin; kehamilan lewat waktu; infeksi fetus. 2. Faktor Ibu Hipoksia ibu karena anemia berat, penyakit paru kronis; menurunnya aliran darah dari ibu ke fetus pada hipotensi karena pendarahan, preeklamsia, eklamsia, diabetes millitus; obat yang berlebihan pada ibu 3. Faktor Plasenta Pertukaran gas antara ibu dan janin dapat dipengaruhi oleh luas dan kondisi plasenta. Asfiksia janin akan terjadi bila terdapat gangguan mendadak pada plasenta, misalnya solusio plasenta, pendarahan plasenta dan lain-lain.
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2.3.
Patofisiologi
Proses kelahiran selalu menimbulkan asfiksia ringan yang bersifat sementara, proses ini dianggap perlu untuk merangsang kemoreseptor pusat pernapasan agar terjadi primary gasping yang kemudian berlanjut dengan pernapasan teratur. Sifat asfiksia ini tidak mempunyai pengaruh buruk karena reaksi adaptasi bayi dapat mengatasinya. Kegagalan pernapasan mengakibatkan gangguan pertukaran oksigen dan karbondioksida sehingga menimbulkan berkurangnya oksigen dan meningkatnya karbondioksida, diikuti dengan asidosis respiratorik. Apabila proses berlanjut maka metabolisme sel akan berlangsung dalam suasana anaerob yang berupa glikolisis glikogen sehingga sumber utama glikogen terutama pada jantung dan hati akan berkurang dan asam organik yang yang terjadi akan menyebabkan asidosis metabolik. metabolik. Pada tingkat selanjutnya akan terjadi perubahan kardiovaskular yang disebabkan beberapa keadaan diantaranya:
9
a. Hilangnya sumber glikogen dalam jantung akan mempengaruhi me mpengaruhi fungsi jantung b. Terjadinya asidosis metabolik mengakibatkan menurunnya sel jaringan termasuk otot jantung sehingga menimbulkan kelemahan jantung c. Pengisian udara alveolus yang kurang adekuat menyebabkan tetap tingginya resistensi pembuluh darah paru, sehingga sirkulasi darah ke paru dan sistem sirkulasi tubuh lain mengalami gangguan. 2.4.
Gambaran Klinis
Secara klinis, gambaran bayi baru lahir yang mengalami asfi ksia akan menunjukkan gejala seperti berikut: a. Pernapasan terganggu (distres pernapasan)
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Anamesis diarahkan untuk mencari faktor resiko terhadap terjadinya asfiksia neonatorum, baik faktor neonatus, faktor ibu, dan faktor plasenta. Anamesis yang kuat dan menunjukkan tndatanda
asfiksia
neonatus
ini
dapat
membantu
menegakkan
4
diagnosis.
2. Pemeriksaan Fisik Asfiksia dapat terjadi selama masa periode intrauterine atau antepartum, durante partum maupun post partum. Bila bayi mengalami asfiksia intrauterine berarti bayi tersebut mengalami kejadian gawat janin atau fetal distress. Penegakan diagnosis asfiksia durante atau postpartum dapat ditegakkan dengan cara nilai APGAR score pada menit 1,5,10, dan 15.
4
7,8,10
Cara memnetukan score APGAR
1) Bayi baru lahir diletakkan dibawah radiant heater 2) Pemeriksaan dilakukan pada menit pertama dan menit kelima setelah lahir 3) Bila penilaian menit ke-5 <7, penilaian dilanjutkan setiap 5 menit sampai menit ke-20 4) Penilaian APGAR meliputi 5 kriteria (Tabel 1). Tabel 2.1 Nilai APGAR Nilai
0
1
2
Nafas
Tidak ada
Tidak Teratur
Tangisan Kuat
Denyut
Tidak ada
<100x/menit
>100x/menit
Jantung
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•
Nilai 0-3 : Asfiksia Berat
•
Nilai 4-6 : Asfiksia Sedang
•
Nilai 7-10 : Normal
Nilai APGAR diperhatikan pada menit me nit ke-1 dan menit ke-5. bila bil a nilai APGAR 5 menit masih kurang dari 7, penilaian dilanjutkan tiap 5 menit sampai scorenya mencapai 7. Niali APGAR berguna untuk menilai keberhasilan resusitasi bayi baru lahir dan menentukan prognosis, bukan untuk memulai resusitasi resusi tasi dimulai 30 detik setelah lahir bila bayi tidak menangis secara spontan.
10
3. Pemeriksaan Penunjang a. Laboratorium
2,3
1) Hasil analisis gas darah tali pusat menunjukkan hasil asidosis pada tali darah pusat 2) PaO2< 50mm H2O 3) PaCO2> 55mm H2O 4) pH < 7,30 Bila bayi sudah tidak membutuhkan bantuan resusitasi aktif pemeriksaan
penunjang
diarahkan
pada
kecurigaan
3
komplikasi, berupa : 1) Darah perifer lengkap 2) Analisa gas darah sesudah lahir 3) Gula darah sewaktu 4) Elektrolit darah (kalsium, Natrium, Kalium) 5) BUN/SC 6) Laktat
atas
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2.6. Tatalaksana 5
Prinsip tatalaksana bayi baru lahir yang mengalami asfiksia meliputi : 1) Segera nilai keadaan sesudah bayi lahir, apakah bernapas spontan dan tonus otot baik. 2) Pastikan bayi tetap hangat, bersihkan jalan napas, keringkan dan beri stimulasi. 3) Berikan ventilasi tekanan positif, dengan pematauan saturasi oksigen. 4) Pertimbangkan intubasi apabila saturasi tidak adekuat at au Laju Denyut Jantung Bayi kurang dari 60 kali per menit. Langkah awal dalam stabilisasi
5
a) Memberikan Memberikan kehangatan
Bayi diletakkan dibawah alat pemancar panas (radiant (radiant warmer ) dalam keadaan telanjang agar panas dapat mencapai tubuh bayi dan memudahkan eksplorasi seluruh tubuh. Bayi dengan BBLR memiliki kecenderungan tinggi menjadi hipotermi dan harus mendapat
perlakuan
khusus.
Beberapa
kepustakaan
merekomendasikan pemberian teknik penghangatan tambahan seperti penggunaan plastik pembungkus dan meletakkan bayi dibawah pemancar panas pada bayi kurang bulan dan BBLR. Alat lain yang bisa digunakan adalah alas penghangat.
8,10
b) Memposisikan bayi dengan sedikit mengadah kepalanya
Bayi diletakkan telentang dengan leher sedikit tengadah dalam posisi menghidu agar a gar posisi farings, larings dan trakea dalam satu garis lurus yang akan mempermudah masuknya udara. Posisi ini
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suctioning),
namun
bukti
penelitian
dari
beberapa
senter
menunjukkan bahwa cara ini tidak menunjukkan efek yang bermakna dalam mencegah aspirasi mekonium.Cara yang tepat untuk membersihkan jalan napas adalah bergantung pada keaktifan bayi dan ada/tidaknya mekonium. Bila terdapat mekoneum dalam 10
cairan amnion dan bayi tidak bugar (bayi mengalami depresi pernapasan, tonus otot kurang dan frekuensi jantung kurang dari 100x/menit) segera dilakukan penghisapan trakea sebelum timbul pernapasan
untuk
Penghisapan
mencegah
trakea
sindrom
meliputi
aspirasi
langkah-langkah
mekonium. pemasangan
laringoskop dan selang endotrakeal ke dalam trakea, kemudian dengan kateter penghisap dilakukan pembersihan daerah mulut, faring dan trakea sampai glotis. Bila terdapat mekoneum dalam cairan amnion namun bayi tampak bugar, pembersihan sekret dari jalan napas dilakukan seperti pada bayi tanpa mekoneum.
11
d) Mengeringkan Mengeringkan bayi, merangsang pernapasan dan meletakkan pada posisi yang benar
-
Meletakkan pada posisi yang benar, menghisap sekret, dan mengeringkan akan memberi rangsang yang cukup pada bayi untuk memulai pernapasan. Bila setelah posisi yang benar, penghisapan sekret dan pengeringan, bayi belum bernapas
adekuat,
maka
perangsangan
taktil
dapat
dilakukan dengan menepuk atau menyentil telapak kaki, atau dengan menggosok punggung, tubuh atau ekstremitas 10
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1) Ventilasi Tekanan Postif 2) Kompresi dada 3) Pemberian epinefrin dan atau pengembang volume (volume ( volume expander ) Keputusan untuk melanjutkan dari satu kategori ke kategori berikutnya ditentukan dengan penilaian 3 tanda vital secara simultan (pernapasan, frekuensi jantung dan warna kulit). Waktu untuk setiap langkah adalah sekitar 30 detik, lalu nilai kembali, dan putuskan untuk melanjutkan ke langkah berikutnya.
7,8
4) Penilaian Penilaian dilakukan setelah 30 detik untuk menentukan perlu tidaknya resusitasi lanjutan. Tanda vital yang perlu dinilai adalah sebagai berikut: 1) Pernapasan Resusitasi berhasil bila terlihat gerakan dada yang adekuat, frekuensi dan dalamnya pernapasan bertambah setelah rangsang taktil. Pernapasan yang megap-megap adalah pernapasan yang tidak efektif dan memerlukan intervensi lanjutan. 2) Frekuensi Jantung Frekuensi jantung harus diatas 100x/menit. Penghitungan bunyi jantung dilakukan dengan stetoskop selama 6 detik kemudian
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DIAGRAM ALUR RESUSITASI NEONATUS
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Terapi medikamentosa: medikamentosa:
10
1) Epineprin 1. Indikasi -
Denyut jantung bayi < 60 x/menit setelah paling tidak 30 detik dilakukan ventilasi adekuat dan pemijatan dada.
-
Asistolik.
2. Dosis -
0,1-0,3 ml/kg BB dalam larutan 1 : 10.000 (0,01 mg0,03 mg/kg BB).
3. Cara -
IV atau endotrakeal.
-
Dapat diulang setiap 3 – 3 – 5 5 menit bila perlu.
2) Volume ekspander 1. Indikasi -
Bayi baru lahir yang dilakukan resusitasi mengalami hipovolemia dan tidak ada respon dengan resusitasi
-
Hipovolemia kemungkinan akibat adanya perdarahan atau syok. Klinisditandai adanya pucat, perfusi buruk, nadi kecil
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1. Indikasi -
Depresi pernapasan pada bayi baru lahir yang ibunya menggunakan narkotik 4 jam sebelum persalinan Jangan diberikan pada bayi baru lahir yang ibunya baru dicurigai sebagai pemakaiobat narkotika sebab akan menyebabkan tanda with drawl tiba-tiba tiba-tiba pada sebagian bayi.
2. Dosis -
0,1 mg/kg BB (0,4 mg/ml atau 1 mg/ml).
3. Cara -
Intravena, endotrakeal atau bila perpusi baik diberikan intramuskular atau subkutan.
4) Birkarbonat 1. Indikasi -
Asidosis metabolik, bayi-bayi baru lahir yang mendapatkan resusitasi. Diberikan bila ventilasi dan sirkulasi sudah baik.
-
Penggunaan bikarbonat pada keadaan asidosis metabolik dan hiperkalemia harus disertai dengan pemeriksaan analisa gas darah dan kimiawi.
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3) Necrotizing Enterocolitis (NEC) 4) Gagal Ginjal Akut (GGA) Kelainan yang terjadi akibat hipoksia dapat timbul pada stadium akut dan dapat pula terlihat beberapa waktu setelah hipoksia berlangsung. Pada keadaan hipoksia akut akan terjadi redistribusi aliran darah sehingga organ vital seperti otak, jantung, dan kelenjar adrenal akan mendapatkan aliran yang lebih banyak dibandingkan organ lain seperti kulit, jaringan muskuloskeletal serta organ-organ rongga abdomen dan rongga toraks lainnya seperti paru, hati, ginjal, dan traktus 8
gastrointestinal.
Perubahan resistensi vaskular inilah yang dianggap menjadi penyebab utama redistribusi curah jantung pada penderita, hipoksia dan iskemia neonatus. Faktor lain yang dianggap turut pula mengatur redistribusi vaskular antara lain timbulnya rangsangan vasodilatasi serebral akibat hipoksia yang disertai akumulasi karbon dioksida, meningkatnya aktivitas saraf simpatis dan adanya aktivitas kemoreseptor yang diikuti pelepasan vasopresin. Redistribusi aliran darah pada penderita hipoksia tidak hanya terlihat pada aliran sistemik tetapi juga terjadi saat darah mencapai suatu organ tertentu. Hal ini dapat terlihat pada aliran darah otak yang ditemukan lebih banyak mengalir ke batang otak dan berkurang
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angka kernatian bayi kurang bulan, terutama bayi berat lahir sangat rendah yang mengalami hipoksia berat dapat mencapai 43-58%.
10
Gambaran klinik yang terlihat pada berbagai organ tubuh tersebut sangat bervariasi tergantung pada beratnya hipoksia, selang waktu antara pemeriksaan keadaan hipoksia akut terjadi, masa gestasi bayi, riwayat perawatan perinatal, serta faktor lingkungan penderita termasuk faktor sosial ekonomi. Beberapa penelitian melaporkan, organ yang paling sering mengalami gangguan adalah susunan saraf pusat. Pada asfiksia neonatus, gangguan fungsi susunan saraf pusat hampir selalu disertai dengan gangguan fungsi beberapa organ lain (multiorgan failure). Kelainan susunan saraf pusat yang tidak disertai gangguan fungsi organ lain, hampir pasti penyebabnya bukan asfiksia perinatal. 2.8
Prognosis
10,11
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BAB III RESPONSI KASUS
3.1.
Identitas Pasien
Nama
: By PMW
Jenis Kelamin
: Laki-Laki
Tanggal Lahir
: 13 Juli 2017
Umur
: 0 bulan 13 hari
Alamat
: Desa Tanjung Benoa, Kuta Selatan
Agama
: Islam
Nomor RM
: 17030148
Tanggal MRS
: 13 Juli 2017
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Riwayat Prenatal
- Antenatal Care (ANC) dikatakan teratur dan dilakukan setiap bulan di bidan. -
Ibu pasien mengatakan pernah melakukan USG (2 kali) di dokter spesialis kebidanan dan kandungan, dengan hasil tidak ada perdarahan dan tampak kelainan.
-
Haid terakhir pada tanggal 8 Januari 2017.
-
Riwayat penggunaan obat sedasi, analgesi, ataupun anestesi disangkal oleh ibu.
Riwayat Intranatal
-
G1P0000 dengan usia kehamilan 30 minggu 6 hari.
-
Pasien lahir tanggal 13 Juli 2017 pukul 14.30 WITA.
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3.3.
Pemeriksaan Fisis
Pemeriksaan fisis pada saat di VK IGD tanggal 13 Juli 2017 Status Present
Aktifitas Tonus Tonus refleks ATR : lemah Tangis
: merintih
Nadi
: 140 kali/menit
Respiration Rate
: 40 kali/menit
Temperatur aksila
: 36,7°C
Berat Badan
: 5,9 kg
Panjang Badan
: 42 cm
Lingkar Kepala
: 31 cm
Lingkar Dada
: 27 cm
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Leher Inspeksi
: benjolan (-), bendungan vena jugularis (-).
Palpasi
: pembesaran kelenjar (-).
Thoraks Jantung Inspeksi
: iktus kordis tidak terlihat.
Palpasi
: thrill (-)
Auskultasi
: S1S2 tunggal regular, murmur (-)
Paru Inspeksi
: gerakan dada simetris, retraksi (-)
Palpasi
: gerakan dada simetris
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Tabel 3.1. Pemeriksaan Darah Lengkap Parameter
WBC
Hasil
Nilai Rujukan
14,58
9,10-34,0
Remarks
•
NE%
21,32
65,90-69,10
Rendah
•
LY%
92,23
27,40-30,80
Tinggi
•
MO%
7,22
0,0-10,30
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Foto Thorax AP :
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Parameter
Hasil
Satuan
Asam Urat
3,3
Mg/dl
Kalsium (Ca)
9,3
Mg/dl
Natrium (Na)-
132
Mmol/L
Serum
Nilai
Rujukan
2.00-7.00
136-145
Remarks
Metode
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Hematologi Parameter
Hasil
Satuan
Nilai
Rujukan
IT Ratio
3.6.
0,03
Diagnosis Kerja
<0.20
Remarks
Metode
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Follow Up Pasien Tabel 3.3 Follow Up Pasien Tanggal
Subyektif, Obyektif, Assesment Assesment
Terapi dan Planning Diagnosis
13/7/2017
S: Instabilitas suhu tidak ada, letargi tidak
•
Rawat Inkubator
17.30 WITA
ada
•
Kebutuhan
cairan
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