Dengan ini menyatakan, menjamin bahwa laporan kunjungan kasus keluarga yang
diserahkan kepada bagian Ilmu Kesehatan Masyarakat Fakultas Kedokteran Universitas
Tarumanagara, berjudul :
Merupakan hasil karya kami, semua sumber baik yang dikutip maupun dirujuk telah
kami nyatakan dengan benar dan tidak melanggar ketentuan plagiarisme dan
otoplagiarisme. Pernyataan ini dibuat dengan penuh kesadaran dan tanpa unsur paksaan
dari pihak manapun
Penulis memanjatkan puji dan syukur kepada Tuhan Yang Masa Esa karena
rahmat-Nya yang melimpah, laporan kasus Kunjungan Kedokteran Keluarga dengan
judul “Laporan Kunjungan Kasus Diabetes Melitus Tipe 2 dengan Neuropati
Diabetikum pada Ny. U dengan Pendekatan Kedokteran Keluarga di Wilayah Kerja
Puskesmas Sindang Jaya, Kecamatan Sindang Jaya, Kabupaten Tangerang Provinsi
Banten Periode 16 Oktober 2017 – 16 November 2017” telah selesai dengan baik dan
tepat pada waktunya.
Laporan ini dibuat dengan tujuan untuk memenuhi tugas Kepaniteraan Klinik
Ilmu Kesehatan Masyarakat Fakultas Kedokteran Universitas Tarumanagara. Keluarga
yang dipilih berada di Desa Sindang Panon, Kecamatan Sindang Jaya, Kabupaten
Tangerang, Provinsi Banten, Periode 16 Oktober 2017 – 16 November 2017.
Penulis ingin mengucapkan terimakasih yang sebesar-besarnya kepada:
1. Drg. Hj. Naniek Isnaini L., M.kes, selaku Kepala dinas kesehatan
Kabupaten Tangerang
2. dr. Dewi Anita Etikasari selaku Kepala Puskesmas Sindang Jaya
3. Para dokter di Puskesmas Sindang Jaya
4. Segenap staf Puskesmas Sindang Jaya
5. dr. Erni Herminjanti G, M.Kes selaku pembimbing kelompok
6. Ny. U dan keluarga
Penulis menyadari bahwa laporan yang dibuat ini masih belum sempurna. Oleh
karena itu, penulis mengharapkan kritik dan saran yang dapat membangun untuk
menyempurnakan dan memperbaiki laporan ini. Sehingga hasil laporan ini bermanfaat
bagi semua pihak. Akhir kata penulis mengucapkan terima kasih.
Penulis
Ni Putu Kusuma Dewi1, Peter Gunardi1, Dede Satria Sabarudin1, Erni Hermijanti2,
Idawati Kardjadidjaja3
ABSTRAK
1
Mahasiswa kepaniteraan IKM FK Untar
2
Bagian Ilmu Kesehatan Masyarakat FK Untar
3
Bagian Ilmu Gizi FK Untar
Bagian Ilmu Kesehatan Masyarakat
Fakultas Kedokteran Universitas Tarumanagara
Periode : 9 Oktober 2017 – 2 Desember 2017 v
Case Report of Diabetes Melitus and Neuropati Diabetikum using Family Medicine
Approach in Sindang Jaya Community Health Centre, Tangerang District, Banten
Province
Period of October 9th 2017 – December 2th 2017
Ni Putu Kusuma Dewi1, Peter Gunardi1, Dede Satria Sabarudin1, Erni Hermijanti2,
Idawati Kardjadidjaja3
1
Public Health Clerkship Student, Faculty of Medicine, Tarumanagara University,
Jakarta 11440
2
Public Health Department, Faculty of Medicine, Tarumanagara University, Jakarta
11440
3
Nutrition Department, Faculty of Medicine, Tarumanagara University, Jakarta 11440
Background : Diabetes Mellitus is a metabolic syndrome that causes a high sugar
concentration in our blood (hyperglycemia). WHO said there were prevalence of 108
millions (4.7%) Diabetes Mellitus cases (adult range >18 years old) in 1980 in the world
has increased in number by 422 millions (8.5%) in 2014. Riset Kesehatan Dasar
(Riskesdas) in 2007 and 2013 has recorded there was an increased by 2 times of
Diabetes Mellitus cases compared to 2007. Based on Riskesdas 2013 prevalence of
Diabetes Mellitus in Banten has increased by 0.6% (within range 0.4 – 1.5%) or
158,670 people. Base on Dinas Kesehatan Kabupaten Tangerang, has recorded in 2017
there roughly 5,691 people with Diabetes Mellitus. Puskesmas Sindang Jaya has
recorded from 7 villages under their working area, since 1 January 2017 to 23 October
2017, has been recorded 83 cases of Diabetes Mellitus. Relying on all the data, it shows
that Diabetes Mellitus is one of the major issues in Puskesmas Sindang Jaya and how
important Diabetes Mellitus is in need to be taking care of as soon as possible before
other complication such as Diabetic Neuropathy appears.
Case : A woman, 52 years old came to Puskesmas, she complains about a feeling of
numbness, and weakness on both arms and legs, and an increased of need to pee from a
year ago. She feels an increased of feeling hungry all the time.
Discussion : Approached by family doctor approach and Mandala of Health, issues
were found such as, the lack of knowledge of the patient regarding Diabetes Mellitus
and how to treat the sickness. She didn’t know that the numbness on her both hands and
legs are the complication of her sickness. Several intervention has been done to the
patient within a week, surveillance has been done to improved her knowledge,
discipline and checking her blood glucose level about Diabetes Mellitus.
Key word : Diabetes Mellitus, Diabetic Neurophaty, Family Doctor, Mandala of Health
DAFTAR ISI
Bagian Ilmu Kesehatan Masyarakat
Fakultas Kedokteran Universitas Tarumanagara
Periode : 9 Oktober 2017 – 2 Desember 2017 vi
Halaman Judul....................................................................................................................i
Halaman Pernyataan Orisinalitas......................................................................................ii
Kata Pengantar.................................................................................................................iii
Halaman Pernyataan Persetujuan Publikasi Karya Ilmiah...............................................iv
Abstrak..............................................................................................................................v
Abstract............................................................................................................................vi
Daftar Isi..........................................................................................................................vii
Daftar Tabel.......................................................................................................................x
Daftar Gambar..................................................................................................................xi
Daftar Lampiran..............................................................................................................xii
Daftar Singkatan.............................................................................................................xiii
Bab 1. Pendahuluan.........................................................................................................1
1.1. Latar Belakang................................................................................................1
1.2. Perumusan Masalah........................................................................................3
1.2.1. Pernyataan Masalah.........................................................................3
1.2.2. Pertanyaan Masalah.........................................................................3
1.3. Tujuan.............................................................................................................3
1.3.1. Tujuan Umum..................................................................................3
1.3.2. Tujuan Khusus.................................................................................3
Bab 2. Tinjauan Pustaka.................................................................................................4
2.1. Dokter Keluarga.............................................................................................4
2.1.1. Definisi dan Prinsip Pelayanan Dokter Keluarga............................4
2.2. Diabetes Melitus.............................................................................................5
2.2.1. Definisi............................................................................................5
2.2.2. Etiologi dan Patofisiologi................................................................6
2.2.2.1. Etiologi...................................................................................6
2.2.2.2. Patofisiologi............................................................................6
2.2.3. Epidemiologi...................................................................................8
2.2.4. Faktor Resiko...................................................................................9
2.2.5. Klasifikasi......................................................................................10
2.2.5.1. Diabetes Gestasional.............................................................11
2.2.6. Diagnosis.......................................................................................12
2.2.7. Penatalaksanaan.............................................................................16
2.2.7.1. Pemeliharaan dan Perawatan Kaki.......................................16
2.2.7.2. Perilaku Hidup Sehat............................................................17
2.2.7.3. Terapi Nutrisi Medis.............................................................17
2.2.7.4. Terapi Farmakologis.............................................................18
2.2.8. Komplikasi....................................................................................21
2.2.9. Program Pengendalian Diabetes Melitus.......................................22
2.3. Kerangka Teori.............................................................................................24
Bab 3. Data Klinis..........................................................................................................25
3.1. Identitas Pasien.............................................................................................25
3.2. Anamnesis.....................................................................................................25
3.2.1. Keluhan Utama..............................................................................25
3.2.2. Keluhan Tambahan........................................................................25
3.2.3. Riwayat Penyakit Sekarang...........................................................25
3.2.4. Riwayat Penyakit Dahulu..............................................................27
Bagian Ilmu Kesehatan Masyarakat
Fakultas Kedokteran Universitas Tarumanagara
Periode : 9 Oktober 2017 – 2 Desember 2017 vii
3.2.5. Riwayat Penyakit Keluarga...........................................................28
3.2.6. Riwayat Kebiasaan........................................................................28
3.2.7. Riwayat Pengobatan......................................................................29
3.2.7. Riwayat Sosial, Ekonomi dan Lingkungan...................................29
3.3. Pemeriksaan Fisik.........................................................................................29
3.3.1. Keadaan Umum...................................................................................29
3.3.2. Kesadaran............................................................................................29
3.3.3. Tanda Vital...........................................................................................29
3.3.4. Status Internus.....................................................................................29
3.4. Pemeriksaan Penunjang................................................................................33
3.5. Diagnosa Kerja Puskesmas Sindang Jaya....................................................33
3.6. Terapi yang telah diberikan dari Puskesmas Sindang Jaya..........................33
Bab 4. Data Keluarga dan Lingkungan .....................................................................34
4.1. Struktur Keluarga.........................................................................................34
4.2. Genogram.....................................................................................................36
4.3. Riwayat Imunisasi dan Kesehatan Keluarga................................................37
4.4. Kondisi Ekonomi......................................................................................... 37
4.5. Pola Berobat.................................................................................................38
4.6. Pola Makan...................................................................................................39
4.6.1. Dietary Recall.......................................................................................39
4.7. Kondisi Rumah.............................................................................................39
4.8. Denah Lokasi ...............................................................................................41
4.9. Denah Rumah Pasien....................................................................................42
4.10. Mandala of Health......................................................................................43
Bab 5. Diagnosis Holistik..............................................................................................46
5.1. Resume.........................................................................................................46
5.2. Diagnosis Holistik........................................................................................46
5.2.1. Aspek Personal..............................................................................46
5.2.2. Aspek Klinis..................................................................................46
5.2.3. Aspek Internal................................................................................47
5.2.4. Aspek Eksternal.............................................................................47
5.2.5. Aspek Fungsional .........................................................................48
5.3. Diagnosis Keluarga.......................................................................................48
5.3.1. Bentuk Keluarga............................................................................48
5.3.2. Fungsi Keluarga.............................................................................48
5.3.3. Siklus Kehidupan Keluarga...........................................................50
Bab 6. Rencana Penatalaksanaan Holistik dan Komprehensif.................................51
6.1. Axis I (Aspek Personal) ...............................................................................51
6.2. Axis II (Aspek Klinis) .................................................................................51
6.2.1 Diagnosis................................................................................................52
6.3. Axis III (Aspek Internal)..............................................................................52
6.4. Axis IV (Aspek Eksternal)............................................................................54
6.5. Axis V (Aspek Fungsional) .........................................................................55
Bab 7. Intervensi, Hasil Intervensi dan Prognosis......................................................56
7.1. Intervensi dan Hasil Intervensi.....................................................................56
7.1.1. Aspek Personal..............................................................................56
7.1.2. Aspek Klinis..................................................................................57
7.1.3. Aspek Internal................................................................................59