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
Vitamin A deficiency
Young age
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
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
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
Radiological exam
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
Management
Supportive
Mild symptoms
Inpatient :
IVFD
Oxygen
Analgetic/ antipyretic
Complications
Empyema
Pericarditis
Pnemothorax
Hematologic spread
Meningitis
Osteomyelitis
Suppurative arthritis
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)
KERANGKA KONSEP
Inhalasi/aspirasi bakteri/virus
Faktor resiko: usia,
imunitas, jenis kelamin,
status gizi
Menginfeksi bronkiolus
respiratorius
Leukosit
Netrofil
Reaksi inflamasi
Peningkatan
permeabilitas kapiler
Iritasi mukosa
mukus
Demam
Batuk produktif
Eksudasi infiltrat
Perkusi redup
Sumbat bronkiolus
Ronki basah
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.