Mrs. Minah, 63 years old female, complains of two episodes of urinary incontinence. On both occasions she was unable to reach a bathroom in time to prevent loss of urine. The firts episode occured when she was in her car and the second while she was in a shopping mall. She is reluctant to go out because of this problem urge incontinence. She has no menstrual periode since she was 50. Whitin the last month, her husband died and ever since she stayed with a housemaid.

Physival examination found the body weight is 75 kg, height is 156 cm, the blood pressure is 150/80 mmHg, there is apical-radial pulse defisit, body temperature is 36,50C, there is no exertional dyspnea, fatigue, and headache.

Laboratory finding is within normal limit.

Lumbal densitometry is -3,0 and femoral densitometry is -2,7.

Geriatric Depression Scale (GDS) 6 . MMSE score is 26.

Mrs. Minah so far was in treatment of captopril 12,5 mg, two times daily.

Tutor : dr Msy Rulan Adindya

Klarifikasi Istilah

1. Inkontinensia urin : ketidakmampuan pengendalian pembuangan urine2. Inkontinensia urge : pengeluaran urine secara involunter akibat peregangan orivisium

vesika urinaria misal saat 3. Siklus menstruasi : daur menstruasi yang dialami wanita ketika usia produktif4. Dispnea : pernapasan yang sukar atau sesak 5. Lumbal densitometri : penentuan berbagai variasi ketebalan melalui perbndingan dengan

bahan lain atau standar tertentu6. Kaptopril : obat anti hipertensi golongan ACE inhibitor7. Apikal-radial pulse defisit : perbedaan jumlah denyut jantung di apeks dengan arteri radialis8. GDS : skala yang digunakan untuk mengukur tingkat depresi pada geriatri9. MMSE : pemeriksaan untuk mengukur fungsi kognitif

Identifikasi Masalah

1. Mrs. Minah, 63 years old female, complains of two episodes of urinary incontinence. On both occasions she was unable to reach a bathroom in time to prevent loss of urine. The firts episode occured when she was in her car and the second while she was in a shopping mall. She is reluctant to go out because of this problem urge incontinence

2. She has no menstrual periode since she was 50.3. Whitin the last month, her husband died and ever since she stayed with a housemaid.4. Physival examination found the body weight is 75 kg, height is 156 cm, the blood pressure is

150/80 mmHg, there is apical-radial pulse defisit, body temperature is 36,50C, there is no exertional dyspnea, fatigue, and headache.

5. Laboratory finding is within normal limit.Lumbal densitometry is -3,0 and femoral densitometry is -2,7.Geriatric Depression Scale (GDS) 6 . MMSE score is 26.

6. Mrs. Minah so far was in treatment of captopril 12,5 mg, two times daily.

Analisis Masalah

1. Mrs. Minah, 63 years old female, complains of two episodes of urinary incontinence. On both occasions she was unable to reach a bathroom in time to prevent loss of urine. The firts episode occured when she was in her car and the second while she was in a shopping mall. She is reluctant to go out because of this problem urge incontinencea) Bagaimana fisiologi berkemih ?juber, hendyb) Bagaimana etiologi inkontinensia urine ? cimey, kardiyusc) Bagaimana hubungan usia dan jenis kelamin dengan keluhan? Ramadan, ayud) Bagaimana klasifikasi dari inkontinensia urine ?abang, anggun

2. She has no menstrual periode since she was 50. a) Bagaimana hubungan periode menstruasi atau menopause dengan inkontinensia urine?

Indah , ridhob) Apa dampak dari menopause? Catri, feddy

3. Whitin the last month, her husband died and ever since she stayed with a housemaid.a) Apapengaruh meninggalnya suami dan tinggal bersama pembantu terhadap Ny. Minah ?

kadek , pacongb) Bagaimana cara menentukan status psikologis Ny.Minah ? juber, kardiyusc) Bagaimana hubungan status psikologi dengan inkontinensia urine ? (2arah ) cimey, hendy

4. Physival examination found the body weight is 75 kg, height is 156 cm, the blood pressure is 150/80 mmHg, there is apical-radial pulse defisit, body temperature is 36,50C, there is no exertional dyspnea, fatigue, and headache.

Bagaimana interpretasi dan mekanisme abnormal dari pemeriksaan fisik? Catri , ridho

- Obesitas - Hipertensilihat jnc 7 hubungan- Pulse defisit

5. Laboratory finding is within normal limit.

Lumbal densitometry is -3,0 and femoral densitometry is -2,7.

Geriatric Depression Scale (GDS) 6 . MMSE score is 26.

a) Bagaimana interpretasi dan mekanisme abnormal dari pemeriksaan penunjang? Ramadan, anggun

b) Pemeriksaan Laboratorium apa saja yang dibutuhkan ? ayu, abang

6. Mrs. Minah so far was in treatment of captopril 12,5 mg, two times daily.a) Bagaimana farmakokinetik dari kaptopril? Indah , feddyb) Bagaimana farmakodinamik dari kaptopril ? kadek , pacongc) Bagaimana indikasi dan kontraindikasi dari kaptopril ? dan obat yang paling tepat untuk

diberikan ke Ny. Minah ? juber, abangd) Bagaimana efek samping dari kaptopril ? anggun, cimey

7. Pertanyaan tambahan a) Bagaimana penegakkan diagnosis dan pemeriksaaan penunjang hendy kardiyusb) DD indah ramadanc) WD ayu ridhod) Epidemiologi feddy pacong

1.

e) Etiologi catri kadekf) Faktor resiko juber, pacongg) Patofisiologi hendy, ramadanh) Manifestasi klinis ayu kardiyusi) Tatalaksana cimey, abangj) Pencegahan anggun, indahk) Komplikasi feddy , ridhol) Prognosis catri, kadekm) SKDI juber

Hipotesis

Ny Minah 63 tahun mengalami inkontinensia urin dengn obes hiperte AF osteoporosis

LI minimal 2

1. Inkon urin (anat +fisiologi berkemih) 2. Obesitas 3. Hipertensi4. AF 5. Osteoporosis

Juber, feddy, ridho 1 dan 2

Ayu catri abang kardiyus 2 dan 3

Kadek pacong cimey 3 dan 4

Ramadan, hendy, anggun indah 4 dan 5

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