trigger number five

7/27/2019 Trigger Number Five

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Trigger number five

Ayu Kartika Sari

405080161


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Rhinitis Alergi

Penyakit inflamasi yg disebabkan oleh

reaksi alergi pd pasien atopi yg

sebelumnya sudah tersensitisasi dgn

alergen yg sama serta dilepaskannya

suatu mediator kimia ketika terjadi

paparan ulangan dgn alergen spesifik tsb.


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Klasifikasi

Saat ini digunakan ygberdasarkan klasifikasi WHO,

ada 2 yaitu:a. Intermitten(kadang): gejala

4hari/mgg ATAU > 4mgg


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Manifestasi klinis

Gejala khasnya adalah serangan bersin

berulang

Keluar ingus/rinore yg encer&banyak

Hidung tersumbat

Hidung dan mata gatal, kadang disertai

banyak air mata


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Komplikasi

Polip hidung

Otitis media efusi yg sedang residif,

terutama pada anak2

Sinusitis paranasal


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Sinusitis

Inflamasi mukosa sinus paranasal (sinus

maksilaris, ethmoidalis, sphenoidalis,

frontalis)


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Etiologi

Virus

Rhinitis terutama Rhinitis alergi

Rhinitis hormonal pd wanita hamil

Polip hidung Kelainan anatomi seperti deviasi septum/ hipertrofikonka

Infeksi tonsil

Infeksi gigi Sumbatan KOM

Kelainan imunologik

Diskinesia silia

Penyakit fibrosis kistik


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Faktor predisposisi

Lingkungan berpolusi

Udara dingin dan kering

Kebiasaan merokok


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Manifestasi klinis

Keluhan utama(akut)= HIDUNG TERSUMBAT

Nyeri di daerah sinus

Sakit kepala

Hiposmia/anosmia

Halitosis

PND yg menyebabkan batuk dan sesak pdanak

Sinusitis kronik tidak khas gejalanya.


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Pemeriksaan

Yg terpenting adalah menggunakan CT

Scan


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Penatalaksanaan

Antibiotikuntuk sinusitis kronik

Dekongestan oral dan topikal

Antihistamin tidak rutin diberikan


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Komplikasi

Kelainan orbita

Kelainan intrakranial

Osteomilitis dan abses subperiostal Kelainan paru

P k Eti l i G j l Kh P ik T t L k


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Penyak

it

Etiologi Gejala Khas Pemeriksaan

Penunjang

Tata Laksana

Deviasi

Septum

Trauma/

ketidakseimb

angan

pertumbuhan.

Sumbatan hidung yang

menetap, Pada sisi deviasi

terdapat konka hipotrofi,

sedangkan sebelahnya terjadi

konka hipertrofi akibat

kompensasi.

Pada pemeriksaan terlihat

rongga hidung tidak sama

besarnya antara kanan dan kiri.

Penonjolan tulang/ rawan

septum berbentuk krista/ spina/perlekatan

- Tanpa gejala/

keluhan sangat

ringan tidak perlu

koreksi.

Keluhan nyata

dirujuk untuk

dilakukan reseksi

submukosa atau

septoplasti (reposisi

septum).

Polip

Nasi

Akibat reaksi

hipersensitif

atau reaksi

atopik di

dalam selaputmukosa

hidung

Sumbatan hidung yang

menetap, makin lama makin

berat.

Hiposmia/ anosmia.

Tampak massa putih keabu-abuan/ kuning kemarahan dalam

kavum nasi.

Polip bertangkai sehingga

mudah digerakkan,

konsistensinya lunak, tidak nyeri

tekan, tidak mudah berdarah,

dan tidak mengecil padapemakaian vasokonstriktor.

Rontgen

sinus.

Pembuatan

biakan hapus

dari hidung(sebelum

melakukan

pengeluaran

polip).

Bila polip kecil,

dapat diobati secara

konservatif dengan

kortikosteroid

sistemik/ oral/ topikal.Bila polip besar,

dilakukan ekstrasi

polip dengan senar.

Bila berulang dapat

dirujuk untuk operasi

etmoidektomi

intranasal/ekstranasal.


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Faringitis

Peradangan akut membran mukosa faring

dan struktur lain di sekitarnya


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Gejala

Nyeri tenggorokan

Mual muntah

Faring hiperemis

Demam

Nyeri tenggorokan

Tonsil bengkak

KGB leher anterior bengkak dan nyeri

Uvula bengkak dan merah

Petekie palatum mole

Ruam skarlatina


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Klasifikasi

Saya hanya membahas faringitis akut

karena kasus kita juga ttg faringitis

akut(karena belum lebih dari 14 hari):

>>Faringitis viral

>>Faringitis bakterial

>>Faringitis fungal

J i P b b G j l t d T i


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Jenis

Faringitis

Penyebab

Tbanyak

Gejala tanda Terapi

F.VIRAL Rhinovirus -Demam,

-rinorea,

-mual,-nyeri tenggorok

-susah mnelan

Istirahat,

minum yg cukup,

kumur air hangat,analgetika&tablet hisap,

AV metisoprinol pd infeksi

herpes simpleks

F.BAKTERIAL Strepto

kokus beta

hemolitikus

group A

-Nyeri kepala hebat,

-muntah,

-deman dgn suhu

tinggi,

-JARANG dgn BATUK

antibiotik(penicilin),

kostikosteroid,

analgetika,

kumur dgn air

hangat/antiseptik

F.FUNGAL Candida -nyeri tenggorok dannyeri mnelan

-Mukosa faring

hiperemis

Nystatin,

analgetika

F.GONOREA Kontak

orogenital -Sefalosporin generasi ke-3,

Ceftriakson IM


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Pneumonia

Peradangan parenkim paru, distal dari

bronkiolus terminalis yg mencakup

bronkiolus respiratorius, dan alveoli serta

menimbulkan konsolidasi jaringan parudan gangguan pertukaran gas setempat


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Etiologi

Berdasarkan kuman/ virus

Berdasarkan lokalisasi

Berdasarkan keadaan penderita


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Klasifikasi

Pneumonia di rumah perawatan(PN)

Pneumonia yg terjadi >48jam setelah

dirawat di RS tapi tidak sedang memakai

ventilator

Pneumonia Komunitas(PK)

Pneumonia akibat infeksi di luar RS


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Manifestasi Klinis

Batuk dgn napas cepat

Hidung melebar

grunting Demam

Ada crackles(ronki basah)


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Faktor resiko PK

Usia >65thn

Adanya infeksi paru yg

multilober/nekrotikans, pasca obstruksi

atau aspirasi

Penyakit penyerta(PPOK, DM,

bronkiektasis, gagal ginjal, malnutrisi, dll)

Tanda fisik yg memprediksi mortalitas,

morbiditas dan komplikasi


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Pemeriksaan

Gambaran radiologis berupa pneumonia

alveolar dgn gambaran air bronkogram

Distribusi infiltrat pd segmen apikal lobus

bawah atau inferior lobus

Bentuk lesi berupa kavitasi dgn air fluid

level sugestif

Pembentukan kista


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Leukositosis

Titer antibodi terhadap virus, legionella,

dan mikoplasmatiter tinggi/ kenaikan

titer 4x


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Penatalaksanaan

Bacterial. Doctors usually treat bacterial pneumonia withantibiotics. Stopping medication too soon may cause yourpneumonia to return. It also helps create strains of bacteriathat are resistant to antibiotics.

Viral. Antibiotics aren't effective against most viral forms of

pneumonia. And although a few viral pneumonias may betreated with antiviral medications, the recommendedtreatment generally is rest and plenty of fluids.

Mycoplasma. Mycoplasma pneumonias are treated withantibiotics. Many cases of mycoplasma pneumonia goundiagnosed and untreated. The signs and symptoms mimic

those of a bad chest cold, so some people never seekmedical attention. The symptoms generally go away on theirown.

Fungal. If your pneumonia is caused by a fungus, you'll likelybe treated with antifungal medication.


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Komplikasi

Bacteria in your bloodstream. Pneumonia can be life-threatening wheninflammation from the disease fills the air sacs in your lungs and interfereswith your ability to breathe. In some cases the infection may invade yourbloodstream (bacteremia). It can then spread quickly to other organs.

Fluid accumulation and infection around your lungs. Sometimes fluidaccumulates between the thin, transparent membrane (pleura) coveringyour lungs and the membrane that lines the inner surface of your chest wall a condition known as pleural effusion. Normally, the pleurae are smooth,allowing your lungs to slide easily along your chest wall when you breathe inand out. But when the pleurae around your lungs become inflamed(pleurisy) often as a result of pneumonia fluid can accumulate andmay become infected (empyema).

Lung abscess. A cavity containing pus (abscess) that forms within the areaaffected by pneumonia is another potential complication.

Acute respiratory distress syndrome (ARDS). The pneumonia involvesmost areas of both lungs, making breathing difficult and depriving your bodyof oxygen. Underlying lung disease of any kind, but especially COPD,makes you more susceptible to ARDS.


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TBC

Tuberkulosis (TBC atau TB) adalah suatu

penyakit infeksi yang disebabkan oleh

bakteri Mikobakterium tuberkulosa. Bakteri

ini merupakan bakteri basil yang sangatkuat sehingga memerlukan waktu lama

untuk mengobatinya. Bakteri ini lebih

sering menginfeksi organ paru-parudibandingkan bagian lain tubuh manusia.


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Epidemiologi


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Etiologi

Mycobacterium tuberculosis, sejenis

kuman berbentuk batang dgn panjang 1-

4/um dan tebal 0,3-0,6/um


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Manfes

Batuk terus-menerus selama 3minggu/ lebih Sakit di dada

Batuk berdarah atau berdahak (lendir daribagian dalam paru2)

Letih/ mudah capai

BB

Kehilangan nafsu makan

Demam Menggigil

Berkeringat di malam hari


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Pemeriksaan Penunjang

*A small reaction (5 mm of hard swelling at the site) is considered to be positive inpeople:-Who have HIV-Who are taking steroid therapy-Who have been in close contact with a person who has active tuberculosis*Larger reactions (greater than or equal to 10 mm) are considered positive in:-People with diabetes or kidney failure-Health care workers*In people with no known risks for tuberculosis, a positive reaction requires 15 mm

or more of hard swelling at the site

Purified ProteinDerivative(PPD) adalah

sebuah antigen yg

disuntikan secara

intradermal di bagian

volar lengan bawah.

Setelah 48-72 jam,bagian yg disuntik akan

dievaluasi oleh dokter.


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P t l k IMUNISASI KIE


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Penatalaksanaan IMUNISASI,KIE,

FARMAKO


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Tumor paru

Tipe histologi:

1. Small cell ---------------------20%

2. Squamus carcinoma ---------30%.3. Adenokarsinoma ------------40%

4. Large cell carcinoma --------10%.


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Small cell carcinoma :

- Bersifat agresif, mudah bermetastase.

- Respons terhadap kemoterapi cukup baik.

- Mikroskopik:* Kelompokan sel hiperkromatik dengan inti

moulding (secara sitologi).

* Sel spindle,inti gelap.

* Tersusun berkelompok (sheet, cord).

- Sel tumbuh dari sel neuroendokrine


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Adenokarsinoma. :

- Sering pada wanita.

- Non smokers.

- 2/3 dijumpai di daerah perifer paru.

- Ada 2 jenis:

1. Sel tumor tersusun bentuk acini

dengan jaringan ikat stroma.

2. Sel tumor tersusun sepanjangdinding alveolus ( bronchi alveolar

carcinoma).


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Squamus cell carcinoma :

Hubungan dekat dengan merokok

Tumbuh dari bronchi besar dengan epitel

yang mengalami metaplasi displasi

Sering ada perdarahan dan nekrosis

Berdiferensiasi baik jelek

Metastase ke kelenjar Hilus


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Large cell carcinoma :

- Tumbuh di sentral.

- Sel besar.- Etiologi :

* Rokok : - aktif

-pasifkarena adanya benzypyrene

dan nitrosamine.

* Polusi : industri, asbes, radiasi,

bahan metal.


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Bronchiechtasis


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SALURAN NAPAS BAWAH

BAGIAN

OBSTRUKSI


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Bronkiolitis

swelling and mucus buildup in the smallestair passages in the lungs (bronchioles),

usually due to a viral infection.

usually affects children under the age of 2,with a peak age of 3 - 6 months


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Etiologi

Respiratory syncytial virus (RSV) is the

most common cause.

Other viruses that can cause bronchiolitis

include:

Adenovirus

Influenza

Parainfluenza
http://www.nlm.nih.gov/medlineplus/ency/article/001564.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000080.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001370.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001370.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000080.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001564.htm


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Manifestasi Klinis

Bluish skin due to lack of oxygen (cyanosis) Cough, wheezing, shortness of breath, or

difficulty breathing

Fever

Intercostal retractions

Nasal flaring in infants

Rapid breathing (tachypnea)

Decreased blood oxygen Wheezing and crackling sounds heard

through stethoscope exam of chest
http://www.nlm.nih.gov/medlineplus/ency/article/003215.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003070.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003070.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003215.htm


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Penatalaksanaan

Sometimes, no treatment is necessary. Supportive therapy can include:

-Chest clapping

-Drinking enough fluids. Breast milk or formula are okay for childrenyounger than 12 months. Offer warm lemonade or apple juice if yourchild is over 4 months.

-Breathing moist (wet) air helps loosen the sticky mucus that may bechoking your child. You can use a humidifier to moisten the air yourchild is breathing. Follow the directions that come with thehumidifier.

-Getting plenty of rest

-Do not let anyone smoke in the house, car, or anywhere near your

child.*Antibiotics are not effective against viral infections. Mostmedications have little effect on bronchiolitis. Children in the hospitalmay need oxygen therapy and fluids given through a vein (IV) tostay hydrated.

-In extremely ill children, antiviral medications (such as ribavirin) are

used in rare cases.


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Komplikasi

Airway disease, including asthma, later in

life

Respiratory failure

Additional infection, such as pneumonia
http://www.nlm.nih.gov/medlineplus/ency/article/000145.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000145.htm


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Faktor Resiko

Exposure to cigarette smoke

Age younger than 6 months old

Living in crowded conditions

Lack of breast-feeding

Prematurity (being born before 37 weeks

gestation)


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COPD

Chronic obstructive pulmonary disease (COPD)

refers to chronic lung disorders that result in

blocked air flow in the lungs. The two main

COPD disorders are emphysema and chronic

bronchitis, the most common causes of

respiratory failure.

Emphysema occurs when the walls between

the lung's air sacs become weakened and

collapse. Damage from COPD is usually

permanent and irreversible.


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Chronic bronchitis is most frequently causedby long term irritation of the bronchial tubes.

Bronchitis is considered "chronic" if symptoms

continue for three months or longer. Bronchitis

caused by allergies can also be classified as

chronic bronchitis. Chronic bronchitis is caused

most often by exposure to airborne pollutantssuch as cigarette smoke, excessive dust in the

air, or chemicals. The bronchial lining becomes

inflamed and the constant exposure to such

pollutants begins to cause damage in the

bronchioles (the smaller airways in the lungs).

Symptoms of chronic bronchitis includeshortness of breath or wheezing, chest pain,

and chronic productive cough.


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Asthma

Asthma is a lung disease that makes itharder to move air in and out of yourlungs. There are three things that you

should know about asthma: Asthma is chronic. In other words, you live

with it every day.

It can be serious even life threatening.

There is no cure for asthma, but it can bemanaged so you live a normal, healthy life.


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Etiology

Genetics. Asthma tends to runs in families. Genetics plays animportant role in causing asthma. If your mom or dad have asthma,then you are more likely to have asthma too.

Allergies. Some people are more likely to develop allergies thanothers, especially if your mom or dad had allergies. Certain allergiesare linked to people who get asthma.

Respiratory Infections. As the lungs develop in infancy and earlychildhood, certain respiratory infections have been shown to causeinflammation and damage the lung tissue. The damage that iscaused in infancy or early childhood can impact lung function long-term.

Environment. Contact with allergens, certain irritants, or exposure to

viral infections as an infant or in early childhood when the immunesystem in developing have been linked to developing asthma.


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Predisposition factors

Respiratory Infections. such as a cold, flu, or sinus infection, are the mostcommon cause of asthma symptoms leading to an asthma flare-up

Allergens. Allergens, such as pollen, mold, dust, dust mites, cockroaches,animal droppings, and dander from animals with fur or feathers

Irritants. include perfumes, cleaning fluids, cigarette smoke, air pollution,wood smoke and kerosene heaters.

Exercise. They may produce more mucus leading to asthma symptoms. Emotions. Crying, yelling or even laughing may cause asthmasymptoms. Stress, both personal and work-related, can be a major trigger.

Chemicals. Certain chemicals cause severe asthma symptoms in peoplewith asthma. Seasonal/Time Triggers. Some people with asthmaexperience more problems with symptoms at certain times of the day(during sleeping time when airways tend to close to close some), certain

times of the month (hormonal changes in women during pregnancy ormenstruation), or certain times of the year (when pollen levels are high suchas in the fall and the spring).

Smoking. Tobacco smoke irritates the airways.


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Manifestasi klinis

Wheezing. You may notice a wheezing soundwhen you breathe. Sometimes this happens onlywhen you exercise or have a cold.

Frequent Cough. This may be more common at

night. You may or may not cough up mucus. Shortness of Breath. This is the feeling you can't

get enough air into your lungs. It may occur onlyonce in a while, or often.

Chest Tightness. Your chest may feel tight,especially during cold weather or exercise. Thiscan also be the first sign of a flare-up.


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PATOFISIOLOGI


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Pencegahan

Get a flu shot. Protect your infants and toddlers

from getting the flu. Children 6 months of age

and older are one of the targeted group to

receive the influenza vaccine. If you care for achild less than 6 months of age, it important for

you to get a flu shot to help protect them from

getting sick.

Avoid exposure to tobacco smoke. If you or afamily member smokes, don't smoke around

your child. Make a plan to quit
http://flucliniclocator.org/http://flucliniclocator.org/


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Farmako asthma

Beta adrenoceptor agonist

Theophyline

Corticosteroids

Chromolyn dan Nedocromil

Leukotrien pathway inhibitor

Anti Ig-E monoclonal antibody


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PERBEDAAN PPOK DAN ASMA

PPOK Asma

Umur mula Dekade ke 6 Variasipenyakit paling cepat awal 40

Peran Sangat berperan - kurang berperanmerokok - dpt memperberat

Reversibiliti obstruksi kronik - obs. episodikobstruksi dan menetap - VEP-1 normal

waktu remisiVEP-1 menetap - VEP-1 membaikdgn bronkodilator dgn bronkodilatorsedikit perbaikan


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PPOK Asma

Perjalanan progresif episodikpenyakit lambat

Riwayat jarang sering

alergi

Kapasiti menurun normaldifusi

Hipoksemia kronik jarang

Spirometri dapat membaik perbaikan nyatadgn bronkodilator dgn bronkodilator

trigger number five

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