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Bronkopneumoni

KELOMPOK 2
Fadillah Amrina 04121401005
Dhiya Silfi Ramadini04121401008
Alzena Dwi Saltike 04121401009
Hatina Agsari 04121401012
Avyandara Janurizka 04121401013
M Rezi Rahmanda04121401054
Marisabela Oktaviani Lintang 04121401056
M Gufron Nusyirwan 04121401064
Nia Fitriyanti 04121401079
Dwi Lestari
04111401083
Rofifah Dwi Putri
04111401089
Risfandi Ahmad Taskura
04121901090

SKENARIO

Zumi, bayi laki-laki usia 9 bulan, dibawa ibunya ke dokter dengan keluhan batuk dan
sukar bernafas disertai
demam, sejak dua hari yang lalu dan hari ini keluhannya bertambah berat.

Pemeriksaan Fisik:
Keadaan umum: Tampak sakit berat, kesadaran: kompos mentis,
RR: 68x/menit, Nadi: 132 x/menit, reguler, Suhu: 38,6oC
Panjang badan: 72 cm, Berat badan: 8,5 kg
Keadaan spesifik:
Kepala: nafas cuping hidung (+),
Toraks: Paru:
Inspeksi : simestris, retraksi intercostal, supraclavicula,
Palpasi : stem fremitus kiri=kanan
Perkusi : redup pada basal kedua lapangan paru,
Auskultasi
: peningkatan suara nafas vesikuler, ronki basah halus nyaring, tidak
terdengar wheezing
Pemeriksaan laian dalam batas normal
Informasi tambahan: Tidak ada riwayat atopi dalam keluarga

Pemeriksaan Laboratorium:
Hb: 11,9 gr/dl, Ht: 34 vol%, Leukosit: 18.000/mm3, LED: 18 mm/jam, Trombosit:
220.000/mm3, HItung jenis:
0/2/1/75/20/2, CRP: (-)

Pemeriksaan Radiologi:

Bronkopneum
onii

Magnitude of the Problem


in Indonesia
Pneumonia in children (< 5 years of age)
Morbidity Rate 10-20 %
Mortality Rate 6 / 1000
Pneumonias kill
50.000 / a year
12.500 / a month
416 / a day = passengers of 1 jumbo jet plane
17 / an hour
1 / four minutes

RISK FACTORS FOR PNEUMONIA


OR DEATH FROM ARI
Malnutrition, poor
breast feeding
practices
Lack of immunization

Vitamin A deficiency

Young age

Low birth weight

Increase
risk of
ARI
Crowding
High prevalence
of nasopharyngeal
carriage of
pathogenic bacteria

Cold weather
or chilling
Exposure to air pollution
Tobacco smoke
Biomass smoke
Environmental air pollution

Etiology
Age
Birth to 20 days

Common causes
Bacteria
Escherichia coli
Group B streptococci
Listeria monocytogenes

3 weeks to 3
months

Bacteria
Chlamydia trachomatis
S. pneumoniae

Viruses
Adenovirus

Less common causes


Bacteria
Anaerobic organisms
Group D streptococci
Haemophilus influenzae
Streptococcus pneumoniae
Ureaplasma urealyticum
Viruses
Cytomegalovirus
Herpes simplex virus
Bacteria
Bordetella pertussis
H. influenzae type B and
nontypeable
Moraxella catarrhalis
Staphylococcus aureus
U. urealyticum
Virus
Cytomegalovirus

Etiology
4 months to 5 years

Bacteria
Chlamydia pneumoniae
Mycoplasma pneumoniae
S. pneumoniae

Viruses
Adenovirus
Influenza virus
Parainfluenza virus
Rhinovirus
Respiratory syncytial virus
5 years to adolescence Bacteria
C. pneumoniae
M. pneumoniae
S. pneumoniae

Bacteria
H. influenzae type B
M. catarrhalis
Mycobacterium
tuberculosis
Neisseria meningitis
S. aureus
Virus
Varicella-zoster virus

Bacteria
H. influenzae
Legionella species
M. tuberculosis
S. aureus
Viruses
Adenovirus

PATOFISIOLOGI
STADIUM I: HIPEREMIA/ KONGESTI
Inokulasi mikroorganismerespon peradanganakumukasi sel MN pada
submukosa dan ruang perivaskuler obstruksi parsial pada jalan nafas.
Penyakit bertambah berat jika sel alveolar tipe II kehilangan integritas strukutralnya
produksi surfaktan berkurang, sehingga terjadi edema

STADIUM II: HEPATISASI MERAH


RBC, fibrin, PMNs fills the alveoli

STADIUM III: HEPATISASI KELABU


Leucocytes and fibrin consolidated in infected alveoli

STADIUM IV: RESOLUTION


Exudate absorbed by macrophage

Clinical Manifestation
General symptoms
Fever
Headache
Irritable
Anorexia
GIT symptoms: nausea, vomiting or
diarrhoea

Clinical Manifestation
Respiratory symptoms
Cough
Dyspnea: nasal flaring, chest
indrawing, grunting
Tacypnea
Cyanosis

Physical Findings
Tachpnea
Normal RR
Age

Normal RR (WHO)
Range

Av. Rate
during
asleep

Neonates

30 60

35

1 mo 1 y.o

30 60

30

1 2 y.o

25 50

25

3 4 y.o

20 30

22

5 y.o 9 y.o

15 30

18

10 y.o

15 30

15

Age

RR

< 2 mo

< 60 x/m

2 mo12mo

< 50x/m

1-5 y.o

< 40x/m

5-8 y.o

< 30 x/m

Physical Findings
Nasal flaring

Chest indrawing/retractions

Physical Findings
Cyanosis
Rales/ ronchi

Laboratory Findings
Peripheral WBC (White Blood Cells):
In viral pneumonianormal or elevated
usually not higher than 20,000/mm 3, with
a lymphocyte predominance.
Bacterial pneumonia (occasionally,
adenovirus pneumonia) is often
associated with an elevated WBC count in
the range of 15,000-40,000/mm3 and a
predominance of granulocytes
Low WBC count/ leucopenia poor
prognosis

Laboratory Findings
CRP ( C-reactive protein)
lower in viral infection
No conclusive evident to distinguish
viral or bacterial infection

Radiological exam
Not a routine procedure indicated
for:
Severe clinical symptom
Poor response to therapy
Deterioration in clinical symptoms

Radiological exam
Interstitial infiltrate increased
bronchovasculature, peribronchial
cuffing, hyperaerated
Alveolar infiltrate consolidation with
air bronchogram
Consolidation in one lobe lobar pneumonia

Bronchopneumonia infiltrate spreading


to peripheral area, increased
peribronchial vasculature

Radiological exam

Consolidation in upper right lobe

Management
Causative
Proper and rapid antibiotic
administration key to succesful
management
Empirical antibiotic therapy no
rapid microbiology test early
identification of causative
microorganism not possible
Mild symptoms treat in outpatient
care, oral antibiotic

Management
Causative inpatient
Broad spectrum antibiotic (Example in Moh.
Hoesin Hospital):
Ampicillin 100 mg/BW/day div. in 3-4 doses +
Chloramphenicol (div in 3-4 doses):
< 6 mo : 25-50 mg/BW/day
> 6 mo : 50-75 mg/BW/day OR

Gentamycin 3 5 mg/BW/day(in 2 doses),


Severe clinical symptoms or laboratory finding
suggesting sepsis ceftazidime 50-100
mg/BW/day (div 2-3 doses)

Management
Supportive
Mild symptoms
Inpatient :
IVFD
Oxygen
Analgetic/ antipyretic

Complications

Empyema
Pericarditis
Pnemothorax
Hematologic spread
Meningitis
Osteomyelitis
Suppurative arthritis

IMCI (Integrated Management of


Childhood Illness)/
MTBS (Managemen Terpadu Balita
Sakit)

IMCI (Integrated Management of Childhood


Illness)/MTBS (Managemen Terpadu Balita Sakit)

Offer simple and effective methods to prevent &


manage the leading causes of serious illness and
mortality in young children

IMCI (Integrated Management of Childhood


Illness)/MTBS (Managemen Terpadu Balita Sakit)

Aimed for:
Young infant aged 1 day-2 months
Children aged 2 months-5 years

To be practiced by:
Paramedic and medical practitioner in
primary health care (puskesmas & pustu):
Paramedic (midwives & nurses)
Physician in primary healthcare (Puskesmas)

Not for inpatient care / ward

KERANGKA KONSEP
Inhalasi/aspirasi bakteri/virus
Faktor resiko: usia,
imunitas, jenis kelamin,
status gizi
Menginfeksi bronkiolus
respiratorius

Leukosit

Shift to the left

Netrofil

Reaksi inflamasi

Peningkatan
permeabilitas kapiler

Iritasi mukosa

mukus

Demam

Batuk produktif

Eksudasi infiltrat

Perkusi redup

Sumbat bronkiolus

Ronki basah

Kolaps (karena tidak


ada cincin kartilago)
Konsolidasi

Compliance

Perfusi oksigen

sesak

Kompensasi pernafasan:
Retraksi intracostal,
supraklavikula
Nafas cuping hidung

KESIMPULAN
Zumi, bayi laki-laki usia 9 bulan,
menderita bronkopneumonia dengan
gejala batuk dan sukar bernafas
disertai demam yang bertambah
berat sejak dua hari yang lalu.