tutorial bronkiolitis

8/16/2019 Tutorial Bronkiolitis

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SMF/Lab Ilmu Kesehatan Anak Tutorial Kasus Pulmonologi

Fakultas Kedokteran Umum

Universitas Mulawarman

B!"K!P"#UM!"IA $A" B!"KI!LITIS

Disusun Oleh:

$esire B% Palada &'(&&()&&'

S*ahidah Amani**a &'(&&()&+,

Pembimbing :

dr% -.% Sukartini S0%A

$ibawakan $alam angka Tugas Ke0aniteraan Klinik

SMF/Lab Ilmu Kesehatan Anak

SU$ Abdul 1ahab S.ahranie Samarinda

Fakultas Kedokteran Umum

Universitas Mulawarman

2&(3

1


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$AFTA ISI

BAB 1 PENDAHULUAN.......................................................................................1

BAB 2 LAPORAN KASUS....................................................................................3

BAB 3 TINAUAN PUSTAKA.............................................................................1!

BAB ! PE"BAHASAN........................................................................................23

BAB # PENUTUP.................................................................................................2#

DA$TAR PUSTAKA.............................................................................................2%

2


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BAB I

P#"$A-ULUA"

B&'n(i'li)is me&u*+(+n *en,+(i) s+lu&+n *e&n+*+s+n b+,i ,+ng l+-im

+(ib+) /+&i 'bs)&u(si s+lu&+n *e&n+*+s+n (e0il. Pen,+(i) ini )e&+/i sel+m+ umu& 2

)+hun *e&)+m+ /eng+n insi/en *un0+( *+/+ se(i)+& umu& % bul+n /+n (eb+n,+(+n

(+sus g+mb+&+n (linisn,+ menghil+ng /+l+m 1 minggu. N+mun se(i)+& # (+sus

mun0ul e*is'/e be&ul+ng be&u*+ 4hee-ing /+n be&(emb+ngn,+ +sm+ /+l+m

4+()u 2 )+hun se)el+h 'nse) /+&i in5e(si. Insi/ensi )e&)inggi sel+m+ musim /ingin

/+n +4+l musim semi. Pen,+(i) ini )e&+/i se0+&+ s*'&+/i( /+n en/emi(. 12

B&'n(i'li)is )e&u)+m+ /iseb+b(+n 'leh Respiratory Syncitial Virus 6RS78

%9 /+&i (+sus /+n sis+n,+ /iseb+b(+n 'leh ;i&us P+&+in5luen-+e )i*e 12

/+n 3 In5luen-+e B A/en';i&us )i*e 12 /+n # +)+u ",0'*l+sm+. RS7 +/+l+h

*en,eb+b u)+m+ b&'n(i'li)is /+n me&u*+(+n s+)u


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BAB II

LAP!A" KASUS

2%( Identitas

< N+m+ : An. ="

< enis (el+min : L+(i < l+(i

< Umu& : > bul+n

< Al+m+) : S+m+&in/+

< An+( (e : # /+&i # be&s+u/+&+

< "RS : 12 "+&e) 21%

Identitas !rang Tua

< N+m+ A,+h : Tn. ?R

< Umu& : ! )+hun

< Al+m+) : S+m+&in/+

< Pe(e&++n : S4+s)+

< Pen/i/i(+n Te&+(hi& : S"P

< A,+h *e&(+4in+n (e : 2

< N+m+ Ibu : N,. $

< Umu& : 3> )+hun

< Al+m+) : S+m+&in/+

< Pe(e&++n : IRT< Pen/i/i(+n Te&+(hi& : S"P

< Ibu *e&(+4in+n (e : 2

2%2 Anamnesa

An+mnesis /il+(u(+n se0+&+ +ll'+n+mnes+ *+/+ )+ngg+l 1! "+&e) 21%

/eng+n ibu (+n/ung *+sien

2%2%( Keluhan Utama

!


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Ses+( n+5+s

2%2%2 iwa*at Pen*akit Sekarang

P+sien meng+l+mi ses+( n+5+s se+( 3 h+&i S"RS. Ses+( be&si5+) hil+ng

)imbul )i/+( /i*eng+&uhi 'leh 4+()u m+(+n+n +)+u*un *'sisi )i/u&. P+sien )i/+(

*e&n+h meng+l+mi ses+( sebelumn,+ /+n ses+( ,+ng /i+l+mi /i+4+li /eng+n

b+)u( be&/+h+( /+n *ile(. "enu&u) *eng+(u+n ibu *+sien b+)u( be&/+h+( /+n

*ile( /i+l+mi *+sien se+( @ > h+&i S"RS /+h+( /+n *ile( be&4+&n+ bening

)e&(+/+ng (en)+l sehingg+ *+sien suli) un)u( mengelu+&(+nn,+ /+n men+/i

(esuli)+n be&n+5+s. Sel+in i)u *+sien ug+ meng+l+mi /em+m s++) mul+i b+)u(<

*ile( /em+m )i/+( )e&l+lu )inggi )u&un s++) minum 'b+) *+n+s /+n /em+m su/+h

be&hen)i se+( @ 1 h+&i S"RS. Ku&+ng lebih 2 h+&i se)el+h *+sien mul+i

meng+l+mi b+)u(


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‒ =igi (elu+& : > bul+n

‒ Te&sen,um : ! bul+n

‒ "i&ing : # bul+n

‒ Teng(u&+* : # bul+n

‒ Du/u( : <

‒ "e&+ng(+( : <

‒ Be&/i&i : <

‒ Be&+l+n : <

‒ "+su( TK : <

2%2%4 Makan dan Minum Anak

< ASI : "ul+i /ibe&i(+n se+( l+hi& hingg+ usi+ h+&i

< Susu s+*i : se+( usi+ > h+&i hingg+ s++) ini be&u*+ susu

L+0)'gen

< Bubu& susu : /ibe&i(+n se+( usi+ % bul+n

< Bu+h : /ibe&i(+n se+( usi+ > bul+n

2%2%5 Pemeriksaan Prenatal

< Pe&i(s+ /i : Bi/+n

< Pen,+(i)m+s+l+h Keh+mil+n : /is+ng(+l

< Ob+)


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< Kelu+&g+ be&en0+n+ : I,+ be&u*+ KB sun)i( 3 bul+n

2%2%(2 iwa*at Imunisasi

Imunis+si Usi+ s++) imunis+si

I II III I7 B''s)e& I B''s)e& II

BC= 68

P'li' 68 68 68 6' C *e& +il+

An)&'*'me)&i

Be&+) b+/+n : 2 (g

P+n+ng B+/+n : %! 0m

B"I : 13

"enu&u) ?


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"ulu) : Li/+h be&sih 5+&ing Hi*e&emis 6


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2%, Pemeriksaan Penun.ang

Pemeriksaan Laboratorium $arah

Tanggal (2/&,/2&(3$arah Lengka0

Leu('si) 23.!

Hb 132

H0) 3

Pl) 3>.

"C7 !!

"CH 2!

"CHC 332

Kimia $arah

=DS 113#lektrolit Serum

N+ 1!

K !#

Cl 1

Pemeriksaan adiologis


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2%+ $iagnosis Ker.a

B&'n('*neum'ni+ B&'n(i'li)is

2%) Penatalaksanaan

• I7$D D# 1! NS 002! +m• Am*isilin 3 2# mg i;

• =en)+misin 2 # mg i;

• De+me)+s'ne 3 1 mg i;

• PCT /&'* 3 > 00

• O2 1 l*m

2%3 Prognosis

P&'gn'sis *+/+ *+sien ini +/+l+h /ubi+ +/ b'n+m

Follow u0 uangan

T+ngg+l S O A P

1!321%

H


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BB F 2 (g b+)u(

be&/+h+(

68

/em+m 6 00

< O2 1 l*m

1#31%

H


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+(&+l h+ng+)

12


13/45

13


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BAB III

TI"7AUA" PUSTAKA

,%( B!"KI!LITIS

,%(%( $e8inisi

B&'n(i'li)is +/+l+h *en,+(i) s+lu&+n *e&n+5+s+n b+gi+n b+4+h /eng+n

(+&+()e&is)i( (linis be&u*+ b+)u( )+(i*ne+ 4hee-ing /+n +)+u

&h'n(i.B&'n(i'li)is +/+l+h sebu+h (el+in+n s+lu&+n *en+5+s+n b+gi+n b+4+h ,+ng

bi+s+n,+ men,e&+ng +n+(


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me&u*+(+n b+gi+n *en)ing /+&i RS7 un)u( mengin5e(si sel ,+i)u *&')ein =

6+))+0hmen) *&')ein 8 ,+ng mengi(+) sel /+n *&')ein $ 65usi'n *&')ein8 ,+ng

menghubung(+n *+&)i(el ;i&us /eng+n sel )+&ge) /+n sel )e)+ngg+n,+. Ke/u+

*&')ein ini me&+ngs+ng +n)ib'/i neu)&+lis+si *&')e()i5 *+/+ h's). Te&/+*+) /u+

m+0+m s)&+in +n)igen RS7 ,+i)u A /+n B. RS7 s)&+in A men,eb+b(+n ge+l+ ,+ng

*e&n+*+s+n ,+ng lebih be&+) /+n menimbul(+n se(uele. "+s+ in(ub+si RS7 2 < #

h+&i.1

Seuml+h ;i&us /i(en+l seb+g+i *en,eb+b b&'n(i'li)is )el+h se0+&+ n,+)+

/i*e&lu+s /eng+n (ebe&+/++n )es /i+gn'sis ,+ng sensi)i5 /eng+n menggun+(+n

)e(ni( m'le(ul+& )+mb+h+n.

RS7 )e)+* men+/i *en,eb+b # 9 > (+sus. Pen,eb+b l+in )e&m+su( ;i&us

*+&+in5luen-+ )e&u)+m+ *+&+in5luen-+ )i*e 3 in5luen-+ /+n human

metapneumovirus 6H"P78. H"P7 /i)+(si& men,eb+b(+n 3 9 1 (+sus

b&'n(i'li)is. Keb+n,+(+n +n+(


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6maternal neutralizing antibody8 ,+ng &en/+h. Sel+in usi+ b+,i /+n +n+( /eng+n

*en,+(i) +n)ung b+4++n bronchopulmonary dysplasia *&em+)u&i)+s (el+in+n

neu&'l'gis /+n immun'0'm*&'mi-e/ mem*un,+i &esi(' ,+ng lebih bes+& un)u(

)e&+/in,+ *en,+(i) ,+ng lebih be&+). Insi/en in5e(si RS7 s+m+ *+/+ l+(i


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be&b+n/ing )e&b+li( /eng+n &+/ius+&i


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=ambar (% Pembeng(+(+n b&'n(i'li *+/+ b&'n(i'li)is %

An+( ,+ng lebih bes+& /+n '&+ng /e4+s+ +&+ng meng+l+mi b&'n(i'li)is

bil+ )e&se&+ng in5e(si ;i&us. Pe&be/++n +n+)'mi +n)+&+ *+&u


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mening(+) (+&en+ ;'lume *+&u

+n)ib'/i sis)emi( )e&+/i be&s+m++n /eng+n &es*'n imun l'(+l. B+,i usi+ mu/+

mem*un,+i &es*'n imun ,+ng lebih bu&u(. 1

=le-en /(( 6/i(u)i* /+&i B+&


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• He*+& /+n lien )e&+b+ +(ib+) *en/'&'ng+n /i+5&+gm+ (+&en+ )e&)e(+n 'leh

*+&u ,+ng hi*e&in5l+si.

• Se&ing )e&+/i hi*'(si+ /eng+n s+)u&+si '(sigen 2 *+/+ u/+&+ (+m+&.

•P+/+ bebe&+*+ *+sien /eng+n b&'n(i'li)is /i/+*+)(+n ('nung)i;i)is

&ing+n ')i)is me/i+ se&)+ 5+&ingi)is.

• A/+ ben)u( (&'nis b&'n(i'li)is bi+s+n,+ /iseb+b(+n 'leh (+&en+

+/en';i&us +)+u inh+l+si -+) )'(sis 6h,/&'0hl'&i0 ni)&i0 +0i/s sul5u&

/i'i/e8. K+&+()e&is)i(n,+:

o g+mb+&+n (linis M &+/i'l'gis hil+ng )imbul /+l+m bebe&+*+

minggu +)+u bul+n /eng+n e*is'/e +)ele()+sis *neum'ni+ /+n

4hee-ing ,+ng be&ul+ng.

o P&'ses *en,embuh+n meng+&+h (e *en,+(i) *+&u (&'nis.o His)'*+)'l'gi: hi*e&)&'5i /+n )imbun+n in5il)&+) melu+s (e

*e&ib&'n(i+l /es)&u(si /+n /e'&g+nis+si +&ing+n ')') /+n el+s)is

/in/ing mu('s+. Te&min+l b&'n(i'lus )e&sumb+) /+n /il+)+si.

Al;e'li ';e&/is)ensi +)ele()+sis /+n 5ib&'sis.

,%(%4 $iagnosis

Di+gn'sis /+*+) /i)eg+((+n mel+lui +n+mnesis *eme&i(s++n 5isi(

*eme&i(s++n l+b'&+)'&ium /+n *eme&i(s++n *enun+ng l+inn,+.Pe&)+m+ se(+li

/+*+) /i0+)+) b+h4+ b+,i /eng+n b&'n(i'li)is men/e&i)+ su+)u in5e(si &ing+n ,+ng

mengen+i s+lu&+n *e&n+*+s+n b+gi+n +)+s /ise&)+i *engelu+&+n se(&e)


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*e&n+5+s+n &ing+n *+/+ minggu sebelum +4i)+n )e&sebu) )e&+/i *+/+ me&e(+.

Dis+m*ing i)u (i)+ ug+ h+&us men,ing(i&(+n *neum'ni+ +)+u &i4+,+) +)'*i ,+ng

/+*+) men,eb+b(+n 4hee-ing.>

Peme&i(s++n 5isi( mem*e&lih+)(+n se'&+ng b+,i meng+l+mi /is)&es n+5+s

/eng+n 5&e(uensi n+5+s lebih /+&i % (+li *e& meni) 6)+(i*neu8 (+/+ng


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be&0+(


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&es*i&+si bil+ *e&lu /+n nu)&isi. Se)el+h i)u b+&ul+h /igun+(+n b&'n('/il+)'& +n)i

in5l+m+si se*e&)i ('&)i('s)e&'i/ +n)i;i&+l se*e&)i &ib+;i&in /+n *en0eg+h+n /eng+n

;+(sin RS7 RS7 immun'gl'bulin 6 *'l,0l'n+l 8 +)+u Hum+nis RS7 m'n'0l'n+l

+n)ib'/, 6 *+li;i-um+b 8.

Te&+*i '(sigen h+&us /ibe&i(+n (e*+/+ semu+ *en/e&i)+ (e0u+li un)u(

(+sus


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/+&+h u&ine 5eses /+n 0+i&+n se&eb&'s*in+l se0e*+)n,+ /ibe&i(+n +n)ibi')i(+ ,+ng

memili(i s*e0)&um lu+s. Pembe&i+n +n)ibi')i( se0+&+ &u)in )i/+( menunu((+n

*eng+&uh )e&h+/+* *e&+l+n+n b&'n(i'li)is. A(+n )e)+*i (e)e&l+mb+)+n /+l+m

menge)+hui ;i&us RS7 +)+u ;i&us l+in seb+g+i *en,eb+b b&'n(i'li)is /+n

men,+/+&i b+h4+ in5e(si ;i&us me&u*+(+n *&e/is*'sisi )e&+/in,+ in5e(si

se(un/e& /+*+) men+/i +l+s+n /ibe&i(+n +n)ibi')i(+.

Rib+;i&in +/+l+h *u&in nu0le'si/e /e&i;+)e gu+n'sine sin)e)i( be(e&+

mem*eng+&uhi *engelu+&+n messenge& RNA 6mRNA8. Rib+;i&in mengh+mb+)

)&+nsl+si mRNA ;i&us (e/+l+m *&')ein ;i&us /+n mene(+n +()i;i)+s *'l,me&+se

RNA. Ti)e& RS7 bis+ mening(+) /+l+m )ig+ h+&i se)el+h ge+l+ )imbul +)+u se*uluh

h+&i se)el+h )e&(en+ ;i&us. K+&en+ me(+nisme &ib+;i&in mengh+mb+) &e*li(+si;i&us sel+m+ 5+se &e*li(+si +()i5 m+(+ *embe&i+n &ib+;i&in lebih be&m+n5++) *+/+

5+se +4+l in5e(si. 1


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• Seb+g+i +l)e&n+)i5 be&i se5)&i+(s'n 6>


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K'&)i('s)e&'i/ ,+ng /igun+(+n +/+l+h *&e/nis'n me)il*&&e/nis'l'n

hi/&'('&)is'n /+n /e(s+me)+s'n. Un)u( *en,+m++n /il+(u(+n ('n;e&si &+)+


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Pen,eb+b b&'n('*neum'ni+ ,+ng bi+s+ /ium*+i +/+l+h :

1. $+()'& In5e(si

+. P+/+ ne'n+)es 6 h+&i8: Streptokokus group ' Respiratory Sincytial

Virus 6RS78.

b. P+/+ b+,i61


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)e&+/in,+ b&'n('*neum'ni+. "enu&u) sis)em imun *+/+ *en/e&i)+


30/45


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be&si5+) +sim*)'m+)i( *+/+ (u&+ng lebih # '&+ng seh+). A/+n,+ in5e(si ;i&us

+(+n memu/+h(+n Streptococcus pneumoniae be&i(+)+n /eng+n &ese*)'& sel e*i)el

*e&n+5+s+n. i(+ Streptococcus pneumoniae s+m*+i /i +l;e'lus +(+n mengin5e(si

sel *neum+)'si) )i*e II. Sel+nu)n,+ Streptococcus pneumoniae +(+n meng+/+(+n

mul)i*li(+si /+n men,eb+b(+n in;+si )e&h+/+* sel e*i)el +l;e'lus. Streptococcus

pneumoniae +(+n men,eb+& /+&i +l;e'lus (e +l;e'lus mel+lui *'&i /+&i K'hn.

B+()e&i ,+ng m+su( (e/+l+m +l;e'lus men,eb+b(+n &e+(si &+/+ng be&u*+ e/em+

/+&i selu&uh +l;e'lus /isusul /eng+n in5il)&+si sel


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s)+/ium ini be&l+ngsung s+ng+) sing(+) ,+i)u sel+m+ !> +m.

3. S)+/ium III 63 9 > h+&i8

Disebu) he*+)is+si (el+bu ,+ng )e&+/i se4+()u sel


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s+lu&+n n+5+s b+gi+n +)+s sel+m+ bebe&+*+ h+&i. Suhu /+*+) n+i( se0+&+ men/+/+(

s+m*+i 3

*+/+ +4+l *en,+(i)+n+( +(+n men/+*+) b+)u( se)el+h bebe&+*+ h+&i /i m+n+

*+/+ +4+ln,+ be&u*+ b+)u( (e&ing (emu/i+n men+/i *&'/u()i5 .

K+&+()e& /+&i s*u)um ug+ /+*+) mene)u(+n *en,eb+b /+&i

b&'n('*neum'ni+ se*e&)i:

< Streptococus pneumonia : s*u)um be&4+&n+ se*e&)i

(+&+)be&/+&+h

< Psudomonas# &aemophilus /+n Pneumococcus : s*u)um be&4+&n+ hi+u

< +lebsiella : s*u)um be&4+&n+ red currant ,elly

< In5e(si b+()e&i +n+e&'bi0 : s*u)um be&b+u busu(

D+l+m *eme&i(s++n 5isi( *en/e&i)+ *neum'ni+ (hususn,+

b&'n('*neum'ni+ /i)emu(+n h+l


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(e*+l+ n,e&i +b/'men /ise&)+i mun)+h.

b% Pemeriksaan Fisik

"+ni5es)+si (linis ,+ng )e&+/i +(+n be&be/+


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=+mb+& ! : $')' )'&+(s PA *+/+

b&'n('*neum'ni+.

b. C


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*&e/'min+n /+n b+()e&i 1#.

,%2%5% $IA="!SA BA"$I"=

+. B&'n(i'li)is

b. E(s+se&b+si b&'n(e()+sis

0. P+,+h +n)ung

/. As*i&+si ben/+ +sing

e. Abses b+,i

Khusus b+,i :

+. "eningi)is

b. Ileus

,%2%'% P#"ATALAKSA"AA"

Pen+)+l+(s+n++n *neum'ni+ (hususn,+ b&'n('*neum'ni+ *+/+ +n+(

)e&/i&i /+&i 2 m+0+m ,+i)u *en+)+l+(s+n++n umum /+n (husus seb+g+ be&i(u).

% Penatalaksaan mum

+. Pembe&i+n '(sigen lemb+b 2

P+O2 *+/+ +n+lisis g+s /+&+h % )'&&.

b. Pem+s+ng+n in5us un)u( &ehi/&+si /+n ('&e(si ele()&'li).

0. Asi/'sis /i+)+si /eng+n *embe&i+n bi(+&b'n+) in)&+;en+.

.% Penatalaksanaan +husus

+. "u('li)i( e(s*e()'&+n /+n 'b+) *enu&un *+n+s seb+i(n,+ )i/+( /ibe&i(+n

*+/+ 2 +m *e&)+m+ (+&en+ +(+n meng+bu&(+n in)e&*&e)+si &e+(si +n)ib'/i

+4+l.

b. Ob+) *enu&un *+n+s /ibe&i(+n h+n,+ *+/+ *en/e&i)+ /eng+n suhu )inggi

)+(i(+&/i +)+u *en/e&i)+ (el+in+n +n)ung.

0. Pembe&i+n +n)ibi')i(+ be&/+s+&(+n mi(&''&g+nisme *en,eb+b /+n

m+ni5es)+si (linis.Pemilih+n +n)ibi')i( /+l+m *en+ng+n+n *neum'ni+ *+/+

+n+( h+&us /i*e&)imb+ng(+n be&/+s+(+n *eng+l+m+n em*i&is ,+i)u bil+

)i/+( +/+ (um+n ,+ng /i0u&ig+i be&i(+n +n)ibi')i( +4+l 62!


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+. Umu& 3 bul+n bi+s+n,+ /iseb+b(+n 'leh s)&e*)'('(us *neum'ni+

s)+5il'('(us +)+u en)e&' b+0)e&i+0e+l ('mbin+si :

< Penisilin *&'(+m #.S)+5il'('(us : Kl'(s+silin # mg(g2! +m I"I7 3

Hem'5ilus in5luen-+

< Am*isilin #

/eng+n

< $en'(sime)il *enisilin 2#.

/il+(u(+n &ee;+lu+si +*+(+h *e&lu /i*ilih(+n +n)ibi')i( l+in. Bil+

*en/e&i)+ +le&gi )e&h+/+* PPAm*isilin /+*+) /ig+n)i(+n /eng+n

3


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/+n n+*+s 0e*+) )i/+( +/+ l+gi

0 Pe&+4+)+n *enun+ng

< Dem+m PCT

< hee-e b&'n('/il+)'&

< C+i&+n m+in)en+n0e sesui+ umu& +n+(

,%2%(&% K!MPLIKASI

K'm*li(+si bi+s+n,+ seb+g+i h+sil l+ngsung /+&i *en,eb+&+n b+()e&i /+l+m

&'ngg+ )h'&+ 6se*e&)i e5usi *leu&+ em*iem+ /+n *e&i(+&/i)is8 +)+u *en,eb+&+n

b+()e&emi+ /+n hem+)'l'gi. "eningi)is +&)&i)is su*u&+)i5 /+n 's)e'mieli)is +/+l+h

('m*li(+si ,+ng +&+ng /+&i *en,eb+&+n in5e(si hem+)'l'gi.

,%2%((% P!="!SIS

P+/+ e&+ sebelum +/+ +n)ibi')i( +ng(+ m'&)+li)+s *+/+ b+,i /+n +n+( (e0il

be&(is+& /+&i 2 s+m*+i # /+n *+/+ +n+( ,+ng lebih )u+ /+&i 3 s+m*+i #.13

Deng+n *embe&i+n +n)ibi')i( ,+ng )e*+) /+n +/e(u+) m'&)+li)+s /+*+) /i)u&un(+n

s+m*+i (u&+ng /+&i 1 +n+( /+l+m (e+/++n m+lnu)&isi ene&gi *&')ein /+n ,+ng

/+)+ng )e&l+mb+) menunu((+n m'&)+li)+s ,+ng lebih )inggi.

3


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BAB I>

P#MBA-ASA"

Teori Fakta

An+mnesis /+n *eme&i(s++n 5isi( :

=e+l+ B&'n(i'li)is:

• ISPA

• Dem+m

• Dis)&es n+5+s 65&e(uensi n+5+s lebih

/+&i % (+li *e& meni)8 ,+ng/i)+n/+i 'leh b+)u( *+&'(sism+l

4hee-ing /+n ses+( n+*+s (+/+ng<

(+/+ng /ise&)+i si+n'sis /+n n+/i

ug+ bi+s+n,+ mening(+)

• N+5+s 0u*ing hi/ung &e)&+(si *+/+

/+e&+h in)e&('s)+l /+n /+e&+h sub

('s)+l.

• E(s*i&+si ,+ng mem+n+ng

P+sien meng+l+mi ses+( n+5+s se+( 3

h+&i S"RS. Ses+( be&si5+) hil+ng

)imbul )i/+( /i*eng+&uhi 'leh 4+()u

m+(+n+n +)+u*un *'sisi )i/u&. Ses+(

,+ng /i+l+mi /i+4+li /eng+n b+)u(

be&/+h+( /+n *ile(. "enu&u)

*eng+(u+n ibu *+sien b+)u( be&/+h+(

/+n *ile( /i+l+mi *+sien se+( @ > h+&i

S"RS /+h+( /+n *ile( be&4+&n+

bening )e&(+/+ng (en)+l sehingg+

*+sien suli) un)u( mengelu+&(+nn,+

/+n men+/i (esuli)+n be&n+5+s. Sel+in

i)u *+sien ug+ meng+l+mi /em+m s++)

!


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4hee-ing ,+ng /+*+) )e&/eng+&

/eng+n +)+u*un )+n*+ s)e)'s('*

se&)+ )e&/+*+) crackles.

=e+l+ B&'n('*neum'ni+

• ISPA

• Dem+m )inggi se0+&+ men/+/+(

63

• Pe&n+5+s+n 0e*+) /+n /+ng(+l

/ise&)+i *e&n+5+s+n 0u*ing hi/ung

&e)&+(si ')') e*ig+s)&i( in)e&('s)+l

su*&+s)e&n+l /+n si+n'sis /i se(i)+&

hi/ung /+n mulu).

• An+( s+ng+) gelis+h

• . P+/+ +us(ul)+si

/i)emu(+n crackles se/+ng n,+&ing.

mul+i b+)u(.

=DS: 113

N+: 1!

K: !#

Cl: 1

!1


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*ening(+)+n uml+h leu('si) hi)ung

enis leu('si) )e&/+*+) *e&gese&+n (e

(i&i se&)+ *ening(+)+n LED.

• An+lis+ g+s /+&+h• $')' )h'&+

• CRP

• Ui se&'l'gis

• Peme&i(s++n mi(&'bi'l'gi

Pen+)+l+(s+n++n :

B&'n(i'li)is

• Pembe&i+n '(sigen

• Pembe&i+n 0+i&+n /+n (+l'&i

• Pembe&i+n +n)ibi')i0 bil+ belum

menge)+hui ;i&us seb+g+i *en,eb+b

/+n *en0eg+h+n in5e(si se(un/e&:

< +m*isilin+m'(sisilin 62#


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mg (gBB(+li8 I7I" se)i+* %

+m.

< K')&im'(s+s'l: ! mg

T"P(gBB(+li 2 (+li seh+&i

sel+m+ 3 h+&i

BAB >

P#"UTUP

)%( Kesim0ulan

P+sien +n. =" l+(i bul+n /+)+ng /eng+n (eluh+n u)+m+

ses+( n+5+s se+( 3 h+&i S"RS. Be&/+s+&(+n +n+mnesis *eme&i(s++n 5isi( /+n *eme&i(s++n *enun+ng /+*+) /i)eg+((+n /i+gn'sis (e&+ *+/+ *+sien ini +/+l+h

b&'n('*neum'ni+ b&'n(i'li)is.

Se0+&+ umum *eneg+(+n /i+gn'sis +lu& *en+)+l+(s+n++n su/+h sesu+i

/eng+n li)e&+)u& ,+ng +/+. P&'gn'sis *+/+ *+sien ini be&/+s+&(+n *e&+l+n+n

*en,+(i) /+n *en+)+l+(s+n++n ,+ng )el+h /i/+*+)(+n +/+l+h b'n+m.

!3


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$AFTA PUSTAKA

1 O&ens)ein D" B&'n0hi'li)i0. D+l+m Nels'n E E/i)'& Nels'n Te)b''(

'5 Pe/i+)&i0 1#)h e/i)i'n Phil+/el*hi+ 1% h+l : 1!>!#.

2 A. P. U,+n H. O-,u&e( ". Kes(in Q. A5s+& M E. Qilm+- : C'm*+&is'n

O5 T4' Di55e&en) B&'n0h'/il+)'&s In The T&e+)men) O5 A0u)e

B&'n0hi'li)is . /he Internet 0ournal of Pediatrics and 1eonatology% 23

7'lume 3 Numbe& 1

3 Se)i+4+)i L+n/i+ "S "+(mu&i. T+)+l+(s+n+ B&'n(i'li)is 6T&e+)men)

B&'n0hi'li)is8. D+l+m C'n)inuing E/u0+)i'n Ilmu Keseh+)+n An+(

7 K+*i)+ Sele()+ Ilmu Keseh+)+n An+( I7 H') T'*i0s in Pe/i+)&i0s

$K UNAIR Su&+b+,+ : 2#. Diun/uh /+&i 444.*e/i+)&i(.0'm

! ?'&0 H+ll CB B&'n0hi'li)is: &e0en) e;i/en0e 'n /i+gn'sis +n/

m+n+gemen). P+e/i+)&i0s 21 12# 3!2

# C+&&'ll KN e).+ll. in0&e+sing bu&/en +n/ &is( 5+0)'& 5'& b&'n0hi'li)is.

Rel+)e/ me/i0+l ;isi)s in in5+n)s en&'lle/ in + s)+)e he+l)h 0+&e insu&+n0e

*l+n. Pe/i+)&i0s 2> 122 #>


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tutorial bronkiolitis

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