SKENARIO D BLOK 24

INFECTION SCENARIO

A newborn baby was delivered at private clinic, assisted by midwife. He was delivered from a 30
years old women, primigravida. Mrs.Anita, the baby’ s mothers 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 minute 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 length 50 cms, head
circumference 34 cms. He looked hypoactive , tachypnoe, respiratory rate 86 breaths perminute,
there were chest indrawing, grunting could be heard using stethoscope, breathing sound was
normal , saturation 80% using nasal oxygen. Sucking reflex was weak. Heart rate was 168 beats
per minute. Abdomen was tender with normal bowel sound. There were not meconenum staining
at umbilical cord and skin.

II. Klarifikasi istilah

1. Primigravida – kehamilan pertama .

2. Premature ruptured of membrane – pecahnya ketuban sebelum dimulainya proses
persalinan.
3. Tachypnoe – pernapasan yang sangat cepat (> 60 kali per minute).
4. Hypoactive – penurunan abnormal aktivitas motoric dan kognitif yang ditandai
dengam melambatnya pemikiran, pembicaraan dan pergerakan.
5. Meconenum – adalah bahan berlendir yang berwarna hijau tua di dalam usus bayi
cukup bulan.
III. Identifikasi Masalah

1. Mrs Anita 30 years old, primigravida had premature reputed of membrane 5 days ago.
The liquor was thick, smelly and greenish. ( 2)
2. She also had fever since 2 days before delivery. (4)
3. Mrs Anita delivered her baby at the private clinic assisted by midwife the pregnany was
full term and the baby did not cry spontaneously after birth. (1)
4. 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 minute later. After 2 hours
observation the midwife saw the baby still breathing uneasily and had grunting. The baby
was refered to Moh Hoesin Hospital. (3)
5. Physical examination revealed body weight was 3500 grams. Body length 50 cms, head
circumference 34 cms. He looked hypoactive , tachypnoe, respiratory rate 86 breaths
perminute, there were chest indrawing, grunting could be heard using stethoscope,
breathing sound was normal , saturation 80% using nasal oxygen. Sucking reflex was
weak. Heart rate was 168 beats per minute. Abdomen was tender with normal bowel
sound. There were not meconenum staining at umbilical cord and skin. (5)

IV. Analisis Masalah

1. Mrs Anita 30 years old, primigravida had premature ruptured of membrane 5 days ago.
The liquor was thick, smelly and greenish. ( 2)
a) Apa makna klinis dari pernyataan di atas?
b) Apa faktor resiko ketuban pecah dini yang dimiliki Mrs Anita? ( dan
mekanaisme)
c) Apa dampak ketuban pecah dini terhadap ibu dan janin?
d) Bagaimana gambaran dari cairan ketuban yang fisiology and patologi?

2. She also had fever since 2 days before delivery. (4)

a) Bagaimana etiologi dan makna klinis dari pernyataan di atas?
b) Bagaimana dampak demam yang dialami ibu terhadap janin?
 3. Mrs Anita delivered her baby at the private clinic assisted by midwife the pregnany was
full term and the baby did not cry spontaneously after birth. (1)
a) Apa makna klinis dari pernyataan di atas?
b) Bagaimana etiology dan mekansime dari bayi tidak menangis
spontaneously?

4. 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 minute later. After 2 hours
observation the midwife saw the baby still breathing uneasily and had grunting. The baby
was refered to Moh Hoesin Hospital. (3)

a) Bagaimana tatalaksana awal respiratory distress pada kasus?

b) Bagaimana prosedur dari manual suction ?

5. Physical examination revealed body weight was 3500 grams. Body length 50 cms, head
circumference 34 cms. He looked hypoactive , tachypnoe, respiratory rate 86 breaths
perminute, there were chest indrawing, grunting could be heard using stethoscope,
breathing sound was normal , saturation 80% using nasal oxygen. Sucking reflex was
weak. Heart rate was 168 beats per minute. Abdomen was tender with normal bowel
sound. There were not meconenum staining at umbilical cord and skin. (5)

a) Bagaimana interpretasi dari hasil pemeriksaan fisik?

b) Bagaimana mekanisme abnormalitas dari hasil pemeriksaan fisik?
c) Berapa nilai downe score berdasarkan data pada kasus?

V.Hipotesis

Bayi laki laki Ny.Anita ( 30 Tahun) lahir aterm SMK dengan ketuban pecah dini
mengalami respiratory distress suspek infeksi MAS
VI.Template

1. DD
2. How to diagnose
3. WD
4. Definisi
5. Etiology
6. Epidemiologi
7. Faktor Resiko
8. Menifestasi klinis
9. Patogenisis dan Patofisiologi
 10. Tatalaksana
11. Pencegaahan dan edukasi
12. Pemeriksaan penunjang
13. Komplikasi
14. Prognosis
15. SKDI

VII. Learning Issue

1) MAS
2) Ketuban pecah dini
3) Infeksi neonates