Skenario B Blok 4 tahun 2016

Mrs. Tensi , 62 years old , came to the clinic with chief complaints of fatigue and
easily shortness of breath in performing daily activities since 7 days ago.
Daily activites such as walking, climbing stairs and carrying goods will causing
fatigue,palpitations and hortness of bearth. These symptoms are reduced when
she take a rest.
Lately, she had to sleep with a half-sitting position. If she is sleeping with only
pillow, she will awakened in the middle of the night with coughing.
Mrs. Tensi suffered from hypertension since 10 years ago, and the treatment is
irregular. The last drug was captopril was already taen a month ago. She has a
hobby eat foods and snacks that taste salty. She never smoked. She had no
history of asthma bronchiale. And in her family thre are no history of hypertesion.
On physical examination. The general state : compos mentis and cooperative.
BW = 70 KG, HEIGHT = 156 cm. Vital signs : BP = 180/100 mmHg, pulse = 105 x
/ minute, RR = 28/min, temperature = 36,5c. On examination of the neck region
of the external jugular vein appears dilated, jugular venous pressure (5 + 2)
cmH2O,
Auscultation of the thorax : rhonci smooth in both basal lung.
Extrimities : pitting edema of the ankles.
Additional examination. Thorax : cardiomegaly.
Ecg : left ventricular hypertrophy
Doctor diagnose mrs. Tensi suffered CHF (congestive heart failure)

Klarifikasi Istilah
Palpitations : make you feel like ypur heart is beating to hard or too fast,
skipping a beat, or fluttering. (
Hypertension
: tingginya tekanan darah arteri secara tersisten,
penyebabnya mungkin tidak di ketahui atau mungkin disebabkan
oleh penyakit lain (dorlan)
Asthma bronchiale : Keadaan yang ditandai dengan serangan berulang dispanca
paroksisma dengan mengakibatkan spasmodik bronki
Captopril

: Drug that used alone or in combination with other medications to

treat high blood pressure and heart failure. It is also used to
improve survival and reduce the risk of heart failure (medline puls)

Compos mentis

: sadar sepenuhnya; sehat mental

Jugular Venous : one of the veins wich pass down either sid of the neck
Jugular Venous Pressure : is a key measure of fluid status
Edema

: pengumpulan cairan secara abnormal dalam ruang jaringan

interseluler tubuh

Cardiomegaly

: kondisi membesarnya jantung

Rhonci Smooth
: alow pitched wheezing snoring or whistellike sound heart
during auscultation of the chest
Congestive Heart Failure: is common clinical disorder that result in pulmonari
vascular congestion and reduced cardiac output
Coughing

: is an important way to keep your throat and airways clear, but too
much coughing may mean you have a disease or disorder

Left ventricular Hypertrophy : enlargement of the walls of the left side of the
heart
Hypertrophy :
Pembesaran atau pertumbuhan berlebihan organ atau bagian
tubuh akibat peningkatan ukuran sel-sel penyusunnya
ECG : grafik yang menelusuri variasi potensial elektrik yang disebabkan oleh
eksitasi otot jantung daan dideteksi pada permukaan tubuh
Identifikasi masalah
1. Mrs. Tensi , 62 years old , came to the clinic with chief complaints of
fatigue, palpitation and easily shortness of breath in performing daily
activities since 7 days ago.(*****)
2. Lately, she had to sleep with a half-sitting position. If she is sleeping with
only pillow, she will awakened in the middle of the night with coughing.(**)

3. Mrs. Tensi suffered from hypertension since 10 years ago, and the
treatment is irregular. The last drug was captopril was already taen a
month ago.(*)
4. She has a hobby eat foods and snacks that taste salty.(*)
5. She never smoked. She had no history of asthma bronchiale. And in her
family thre are no history of hypertesion. (Fact)
6. On physical examination. The general state : compos mentis and
cooperative. BW = 70 KG, HEIGHT = 156 cm. Vital signs : BP = 180/100
mmHg, pulse = 105 x / minute, RR = 28/min, temperature = 36,5c. On
examination of the neck region of the external jugular vein appears
dilated, jugular venous pressure (5 + 2) cmH2O, (***)
Auscultation of the thorax : rhonci smooth in both basal lung.
Extrimities : pitting edema of the ankles.
Additional examination. Thorax : cardiomegaly.
Ecg : left ventricular hypertrophy
7. Doctor diagnose mrs. Tensi suffered CHF (congestive heart failure). (****)
ANALISIS MASALAH
1. Mrs. Tensi , 62 years old , came to the clinic with chief complaints of
fatigue, palpitation and easily shortness of breath in performing daily
activities since 7 days ago.(*****)
a. Apa hubungan umur, jenis kelamin dan kegiatan sehari-hari dengan
kelelahan, jantung berdebar, dan bernafas pendek?
b. Bagaimana mekanisme terjadinya kelelahan, jantung berdebar, dan
bernafas pendek?
c. Bagian jantung mana yang terganggu ketika keadaan berdebar?
d. Bagian paru-paru mana yang terganggu ketika keadaan nafas pendek?
e. Bagaimana kerja normal jantung,otot,dan paru-paru?
f. Apa indikator terjadinya kelelahan jantung berdebar, nafas pendek?
g. Bagaimana perbedaan antara sistem sirkulasi pernapasan yang normal
dan yang pendek?
2. Doctor diagnose mrs. Tensi suffered CHF (congestive heart failure). (****)
c. Apa jenis-jenis pemeriksaan untuk mendiagnosis CHF?
d. Bagaimana perbedaan anatomi, dan histofisiologi jantung yg normal
dengan CHF?
e. Apa indikator dokter mendiagnosis CHF?
f. Bagaimana epidemiologi,etiologi dan tatalaksana?

3. On physical examination. The general state : compos mentis and

cooperative. BW = 70 KG, HEIGHT = 156 cm. Vital signs : BP = 180/100
mmHg, pulse = 105 x / minute, RR = 28/min, temperature = 36,5c. On
examination of the neck region of the external jugular vein appears
dilated, jugular venous pressure (5 + 2) cmH2O, (***)
Auscultation of the thorax : rhonci smooth in both basal lung.
Extrimities : pitting edema of the ankles.
Additional examination. Thorax : cardiomegaly.
Ecg : left ventricular hypertrophy

a. Bagaimana tanda vital yang normal?

b. Bagaimana hubungan klinik cardian hypertrophy?
c. Bagaimana kerja sistem pernapasan saat terjadinya rhonchi
smooth?
d. Apa yang menyebabkan edema pada ankles?
e. Apa hubungan tanda vital tersebut degan CHF?
f. Bagaimana anatomi pada neck region?
g. Bagaimana struktur mikroskopis Jugular Vein?

4. Lately, she had to sleep with a half-sitting position. If she is sleeping with
only pillow, she will awakened in the middle of the night with coughing.(**)
a. Apa hubungan posisi tidur dengan sistem pernapasan?
b. Apa saja bagian-bagian sistem respirasi?
c. Bagaimana mekanisme batuk?
d. Jaringan apa yang terganggu saat batuk?

5. Mrs. Tensi suffered from hypertension since 10 years ago, and the
treatment is irregular. The last drug was captopril was already taken a
month ago. She has a hobby eat foods and snacks that taste salty (*)
a. Bagaimana mekanisme hipertensi?
b. Bagaimana hubungan hipertensi dengan sistem sirkulasi?
c. Apa penyebab hipertensi?
d. Mengapa obat hipertensi dikonsumsi secara teratur?
e. Bagaimana pengaruh makanan terhadap hipertensi?

Learning issue
1. Sistem pernafasan
a. Anatomi
b. Histologi
c. Fisiologi
d. Mekanisme
e. Short breath
f. Batuk
2. kardiofaskular
a. anatomi
b. histologi
c. fisiologi
d. mekanisme
e. palpitasi
f. hipertensi

g. hipertropi
h. kardiomegaly
3. chf
a.pendekatan diagnostik

4. muskulusskeletal
otot
5. tanda vital