Mini Project

GERAKAN 1 RUMAH 1 JUMANTIK 1 JUMANTUK

UNTUK MENURUNKAN ANGKA KEJADIAN KASUS DBD DAN
MENINGKATKAN CAKUPAN TB PARU DI WILAYAH KERJA
PUSKESMAS SUNGAI DURIAN
TAHUN 2019

OLEH
dr. Andreas Servanel Lase
dr. M. Reza Alfath ZE
dr. Rezeki Amanda

PENDAMPING
dr. Desfarina

PROGRAM DOKTER INTERNSIP INDONESIA

PUSKESMAS SUNGAI DURIAN
KOTA SAWAHLUNTO
PERIODE 12 MARET – JULI 2019
 DAFTAR ISI

Daftar Isi.................................................................................................................. ii
Daftar Gambar ........................................................................................................ iii
Daftar Tabel ........................................................................................................... iv
Daftar Lampiran ..................................................................................................... vi

BAB 1 PENDAHULUAN
1.1. Latar Belakang ..................................................................................................1
1.2. Batasan Masalah................................................................................................7
1.3. Tujuan Penulisan ...............................................................................................7
1.4. Manfaat Penulisan .............................................................................................8

BAB 2 TINJAUAN PUSTAKA

2.a.1. Definisi Tuberkulosis Paru ...........................................................................10
2.a.2. Etiologi dan Faktor Resiko Tuberkulosis Paru.............................................10
2.a.3. Epidemiologi Tuberkulosis Paru ..................................................................11
2.a.4. Klasifikasi Tuberkulosis Paru ......................................................................11
2.a.5. Manifestasi Klinis Tuberkulosis Paru ..........................................................13
2.a.6. Diagnosis Tuberkulosis Paru ........................................................................15
2.a.7. Diagnosis Banding Tuberkulosis Paru .........................................................23
2.a.8. Penatalaksanaan Tuberkulosis Paru .............................................................24
2.a.9. Komplikasi Tuberkulosis Paru .....................................................................28
2.a.10. Prognosis Tuberkulosis Paru ......................................................................29
2.b.1. Defenisi DBD ...............................................................................................31
2.b.2. Etiologi DBD ...............................................................................................31
2.b.3. Epidemiologi DBD.......................................................................................31
2.b.4. Faktor Resiko DBD ......................................................................................32
2.b.5. Patofisiologi dan Patogenesis DBD .............................................................32
2.b.6. Manifestasi Klinis dan Pejalanan Penyakit DBD.........................................37
2.b.7. Diagnosis DBD ............................................................................................41
2.b.8. Diagnosis Banding DBD ..............................................................................43
2.b.9. Penatalaksanaan dan Komplikasi DBD .......................................................44
2.a.10. Pencegahan DBD .......................................................................................55

BAB 3 ANALISIS SITUASI

3.1. Kondisi Geografis Puskesmas Sungai Durian ................................................56
3.2. Kondisi Demografis Puskesmas Sungai Durian .............................................57
3.3. Fasilitas Pelayanan Kesehatan Puskesmas Sungai Durian..............................57
3.4. Ketenagaan Puskesmas Sungai Durian ...........................................................58
3.5. Poliklinik TB dan DBD Puskesmas Sungai Durian ........................................58
3.6. Data Pasien TB dan DBD Puskesmas Sungai Durian .....................................59

BAB 4 PEMBAHASAN
4.1. Identifikasi Masalah ........................................................................................61
4.2. Penentuan Prioritas Masalah ...........................................................................61
4.3. Analisis Sebab Masalah ..................................................................................67
4.4. Diagram Ischikawa..........................................................................................70

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4.5. Perumusan Pendekatan Pemecahan Masalah ..................................................71
4.6. Inventarisasi Rencana Kegiatan ......................................................................72

BAB 5 RENCANA USULAN KEGIATAN

5.1. Rencana Usulan Kegiatan ...............................................................................74
5.2. Analisa Hambatan Potensial ...........................................................................76

BAB 6 RENCANA PELAKSANAAN PROGRAM PDCA

6.1. Plan (Tahap Persiapan) ...................................................................................77
6.2. Do (Tahap Pelaksanaan) .................................................................................77
6.3. Check (Tahap Evaluasi) ..................................................................................79
6.4. Action (Rencana Berkelanjutan) .....................................................................80
6.5. Matriks Kegiatan .............................................................................................81

BAB 7 HASIL DAN PEMBAHASAN ................................................................83

BAB 8 PENUTUP.................................................................................................87

DAFTAR PUSTAKA ...........................................................................................89

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 DAFTAR GAMBAR

Gambar 1.1. Daerah Virus Dengue Ditemukan .....................................................1

Gambar 1.2. Jumlah Kasus DBD di Indonesia ......................................................2
Gambar 1.3. Estimasi Jumlah Kasus Baru TB
dan Incidence Rate TB tahun 2016 ....................................................5
Gambar 1.4. Estimasi Insidens TB Menurut Regional 2016 ..................................5
Gambar 1.5. Jumlah Kasus Baru TB Berdasarkan Jenis Kelamin Tahun 2017 ....6
Gambar 1.6. Estimasi Insidens TB Menurut Regional 2016 ..................................6
Gambar 2.1. Alur Diagnosis TB ..........................................................................20
Gambar 2.2. Patogenesis DBD .............................................................................33
Gambar 2.3. Manifestasi Infeksi Virus Dengue ..................................................38
Gambar 2.4. Manifestasi Expanded Dengue Syndrome ......................................41
Gambar 2.5. Klasifikasi Infeksi DBD dan
Pengelompokan Keparahan DBD ...................................................43
Gambar 2.6. Kebutuhan Cairan Berdasarkan Berat Badan .................................49
Gambar 2.7. Kebutuhan Cairan Infus Dewasa
dan Anak-anak dengan DBD ..........................................................49
Gambar 2.8. Kecepatan Cairan Infus Dewasa
dan Anak-anak dengan DBD ..........................................................50
Gambar 2.9. Kecepatan Cairan Infus pada DBD Derajat 3 ..................................50
Gambar 2.10. Pemeriksaan Laboratorium ABCS untuk
Pasien Syok atau Dengan Komplikasi ..........................................51
Gambar 2.11. Alur Rehidrasi DSS ......................................................................52
Gambar 3.1. Kondisi Geografis Puskesmas Sungai Durian ................................56
Gambar 4.1. Diagram Ishikawa DBD .................................................................70
Gambar 4.2. Diagram Ishikawa TB .....................................................................70
Gambar 7.1. Sosialisasi TB Paru Dan HIV di Rutan............................................84
Gambar 7.2. Kunjungan Rumah Pasien TB Paru .................................................85
Gambar 7.3. Kunjungan Rumah Pasien DBD ......................................................86

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 DAFTAR TABEL

Tabel 2.1. Jenis dan Dosis OAT Kemasan Terpisah Lini Pertama .....................24
Tabel 2.2. Dosis OAT Kemasan KDT Berdasarkan Berat Badan .......................25
Tabel 2.3. Tindak Lanjut Pengobatan Pasien TB Paru Pada Akhir Masa Intensif
dan Lanjutan .......................................................................................26
Tabel 2.4. Efek Samping OAT ............................................................................27
Tabel 3.1. Jumlah Penduduk Wilayah Puskesmas Sungai Durian ......................57
Tabel 3.2. Jumlah Jaringan Pelayanan Kesehatan dan Posyandu Puskesmas
Sungai Durian .....................................................................................58
Tabel 3.3. Data Ketenagaan Puskesmas Sungai Durian Tahun 2019 ..................58
Tabel 3.4. Data Kasus DBD di Wilayah Puskesmas Sungai Durian
Tahun 2018 .........................................................................................59
Tabel 3.5. Data Kasus TB paru di Wilayah Puskesmas Sungai Durian Tahun
2018 .....................................................................................................60
Tabel 4.1. Daftar Permasalahan di Puskesmas Sungai Durian ............................62
Tabel 4.2. Penilaian Prioritas Masalah ................................................................64
Tabel 4.3.a Perumusan Masalah dan Penyebab
Masalah DBD .....................................................................................68
Tabel 4.3.b Perumusan Masalah dan Penyebab Masalah TB Paru ......................69
Tabel 4.4.a Perumusan Pendekatan Pemecahan Masalah DBD ..........................71
Tabel 4.4.b Perumusan Pendekatan Pemecahan Masalah TB Paru ......................72
Tabel 4.5. Inventarisasi Rencana Kegiatan .........................................................73
Tabel 5.1. Rencana Usulan Kegiatan ....................................................................74
Tabel 5.2.a Analisa Hambatan Potensial DBD ....................................................76
Tabel 5.2.b Analisa Hambatan Potensial TB Paru ...............................................76

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 DAFTAR LAMPIRAN

Lampiran 1 Data Pasien Hipertensi di Puskesmas Sungai Durian

Lampiran 2 Hasil Kunjungan Ulang Pasien Baru Dikenal Hipertensi
Lampiran 3 Rincian Pengeluaran Kegiatan
Lampiran 4 SOP Tuberkulosis Paru
Lampiran 5 SOP Hipertensi Urgensi
Lampiran 6 SOP Hipertensi Emergensi
Lampiran 7 Standing Banner Program Bantu Awasi Sadari Hipertensi
Lampiran 8 Standing Banner dan Spanduk Poliklinik Pandu PTM
Lampiran 9 Logo Program Bantu Awasi Sadari Hipertensi
Lampiran 10 Printout Buku Saku Hipertensi
Lampiran 11 Kartu Kontrol Hipertensi
Lampiran 12 Desain Kantong Hipertensi
Lampiran 13 Desain Kartu PMO
Lampiran 14 Stiker Rumah Pasien Hipertensi
Lampiran 15 Pedoman Pelatihan Kader Hipertensi
Lampiran 16 Absensi Pelatihan Kader
Lampiran 17 Surat Undangan Pelatihan Kader Hipertensi
Lampiran 18 Susunan Acara Pelatihan Kader Hipertensi
Lampiran 19 Nilai Pretest dan Posttest Kader
Lampiran 20 Panduan Buku Pegangan Kader Hipertensi
Lampiran 21 Laporan Cakupan Penderita Hipertensi oleh Kader
Lampiran 22 Laporan Pelatihan Kader Peduli PTM
Lampiran 23 Formulir Pengisian di Poliklinik PTM
Lampiran 24 Format Buku Register Poliklinik PTM

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