Aprilia CBD Dr Saugi

8/17/2019 Aprilia CBD Dr Saugi

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Case Based Discussion

Complication Congestive Heart Failure

Lecturer Advisor

dr. HM. Saugi Abduh, SpPD,KKV,F!ASM

Presented byAprilia Nugraheni012116332


3/31

PA!"N !D"N!#

Na$e % &r' (

)e* % &ale

Age % 62th #ears +ld

(eligion % &osle$

,ob % -a$ers

Adress % Cabean ( 0./( 6 De$a &( nu$ber % 01'2'04'5

(oo$ % B' !77ah !!' L

Chec in date % 14 &arch 2016

Chec out date % 30 &arch 2016


4/31

ANA&N")!)Chief complaint " D#spneu and chest pain

Patient came to the slamic hospital Sultan Agung $ith c

complains d#spneu and chest pain since &' month ago. d#s

become aggravate and patient %elt di(cult to breath, d#sp

sleep. Chest pain located on the le%t side. )he patient %elt a

%ullness, s$ollen limbs, abdominal bloating, constipation .

has abdominal %ullnes * month ago.)he patient also comp

$ea+ness and being lethargic, and %ever. Petient is heav#

cigarette since he $as #oung and coee. He has diagnostic

disease &' month ago. His mother have lung disease.


5/31

Past History

DM history (-)

Hypertension (-)

Hyperlipidemia (-)

Heart disease (+): 17 month ago

Smooking cigarette (+)

Overeight (+)

Family History

DM history (-)

Hypertension (-)

Heart disease (-)Overeight (-)

Hyperlipidemia (-)

Personal and social history

!atient is a "amer# hospital cost $y %&'

He has children and all o" them has $een marriage

conomic stat*s : middle-lo


6/31

Review of systems ( Head-to-toe evaluation)

Skin: $ron skin#

Head : headache (+)

ye : blured vision +/+, red eyes --# icteric --

ars: hearing lost --# ring --# discharge --

'ose : $leeding --# discharge --

Mo*th : cyanosis -# thrush -# bleeding gums -

,hroath : pain salloing -, hoarseness +, difficult in swallowing +, snoring-

'eck : enlargment o" the gland - hest : dyspne* +# pain +# co*gh +# $lood-# sp*t*m (+)

ardiac : chest pain +# palpitations +

Stomach : a$dominal pain +# decreassed appetite+# na*sea +# vomiting-#

de"ecation miction -+

M*sc*losceletal : eakness +# rigid -# pain -

.trimity : oedem on *pper and loer e.trimity (+)# /lcers (-)#


7/31

Physical "*a$ination

-eneral status• -eneral " D#spneu, chest pain and oedem

• !utrient Status " H1 &'2cm, 31 45 +g 6M 1 3+g07H 8 m80

1 457*,59':

1 94,'9;2'44 94.4 " over$eight

• *5>above " obese


8/31

Vital Sign

• 6P " &957;5 mmHg

• H? " ;* bpm@ regular ritmic,eualit# same, pulse alternan>0 pulse deBcit >0

amplitude strong.• 6F " 9; times7minute

• )emp "*;.2 degree o% celcius

Head " chepalgia /0#es " anemic conungtive >07>0, icteric >07>0ars " Hearingloss >07>0, discharge >07>0!ose " S#metric, secret>0, nostril breath >0sophagus " h#peremic >0, pain devour>0

Mouth " c#anosis >0, dr# lips /0!ec+ " trachea deviation >0, l#mph h#pertrop# >0Chest" barrel chest /0 ,

E Stomatch " acites /0,S+in " h#perpigmentation achantosis nigricans0/0trimit# " 0, pitting udem /0

!)?P?)A)


9/31

Thorax-pulmonary

inspection Anterior Posterior

)tatic •B8% 30t/$inute•Dia$eter AP9LL•:e$ithora* si7e L;(•:yperpig$entation spidernavi tu$or in?a$ation •)!C% retraction intercosta

•B8% 30t/$inute•Dia$eter AP9LL•:e$ithora* si7e L;(•:yperpig$entation sptu$or in?a$ation •)!C% retraction intercosta

Dyna$ic •:e$ithora* $ove$ent L;(• Additional $ucsle respiration

•:e$ithora* $ove$ent L;• Additional $ucsle respira

Palpation Anterior Posterior

De*tra Palpation pain tu$or ste$-re$itus de*tra;sinistra retractionintercosta

Palpation pain tu$or de*tra;sinistra

)inistra Palpation pain tu$or ste$-re$itus de*tra;sinistra

Palpation pain tu$or de*tra;sinistra


10/31

Auscultation Anterior Posterior

De*tra esicular ronchi hee7ing pleural rub

esicular ronchi hee7ing pleural rub

)inistra esicular ronchi hee7ing pleural rub

esicular ronchi hee7ing pleural rub

Percussion Anterior Posterior

De*tra )hi-ting dullnes )hi-ting dullnes

)inistra )hi-ting dullnes )hi-ting dullnes

interpretation : dyspneu, susp oedem pulmonary


11/31

Thorax-Cardiac

!nspection !ctus cordis seen

Palpation !ctus cordis is palpable on )!C !! linea $id clavicle sinistra t

Percution Dull sound•pper broderline o- heart % )!C !! Linea sternalis sinistr•aist o- heart % )!C !! Linea parasternalis sin•Loer (ight broderline o- heart % )!C ! $id claviculla de*tra•Loer Le-t broderline o- heart % )!C Linea a*illaris ansinistra

Auscultation •Aorta alve % ) ! !! pure reguler ' A1EA2•Pul$onal alve % ) ! !! pure reguler ' P1EP2• riuspidal alve % ) ! !! pure reguler ' 192•&itral alve % ) ! !! pure reguler ' &19&2•Additional sound % interpretation : Susp. Cardiomegali


12/31

Interpretationv Interpretation

Abdomen

!nspection Distention cicatrice striae caput $edusa enlarg$ent o- vein

Auscultation Peristaltic F 1 ti$es / $inute

Percution hy$pani all abdo$inal sur-aceLiver span % de*tra F 13 c$' )inistra F c$'

raubeGs space % )hiting dullness %

Palpation )uperHcial % &ass Deeper % Abdo$inal pain hepato$egali spleeno$egali &urphy signs

Interpretation : susp. Ascites , hepatomegali, spenomegali


13/31

xtrimities Superior n%erior

"de$a @/@ @/@

Cold "*tri$ity =/= =/=

(e?e* physiologist @/@ @/@

!cteric =/= =/=

xtrimities

Interpretation : oedem extrmity, pitting edema

Pitting ede$a /7/ /7/


14/31

8ollo p&4>5*>95&:

95>5*>95&:

9&>5*>95&:

99>5*>95&:

9*>5*>95&:

92>5*>95&:

9=>5*>95&:

9:>5*>95&:

9'>5*95&:

Dyspneu

Dyspneueaness

Le-t leghurt

Le-t leghurt

eanessleg hurt

eaness

eanessde-ecation=

eanessdyspneu

eande-ecan =

120/0 40/0 110/50 120/50 0/0 10/100 130/0 120/0 130/0

3 bp$ = bp$ 100bp$ 63 bp$ 4bp$ 10bp$ 5bp$ 13bp$ 4bp$

30 t/$ = t/$ 22t/$ 2 t/$ 2t/$ 2t/$ 20t/$ 35t/$ 2t/$

36 dc 35 dc 36'5 dc 36'4dc 35'dc 3'dc 34'1dc 34'.dc 35'dc

111 4. 4. 4. 152 10 11 10 116

Date

)

BP

:(

B8

ID)


15/31

LAB+(A+(# "JA&!NA!+ :e$atology and Che$ical&4>5*>95&: ?esult !

APP/PK 236 second 21'=2'0

Control 254 second 20'4=2'3

PP 12 second 4'3=11'

Control 11 second '=12'0

&4>5*>95&: ?esult

Protein otal .3

Albu$in 22

Ilobulin 3'06ID) 111

Conclusion" hipoalbuminemiaeu+ositosis, h#peruricemia,aIotemia

957>5*795&: ?esult !

:e$oglobin 1. 13'5=15'3

:e$atorit 5'6 33=.Leuosit 1'1. 3'=10'6

ro$bosit 3.5 1.0=0

9575*795&: ?esult

ric Acid '

reu$ 62

Creatinin darah 1'.3

Natriu$ 11'4

Kaliu$ '31

Cloride 101'

Calciu$ 4'5

&agnesiu$ 1'4

:BsAg Non reati- N


16/31

K!&!A BL++D IA) ANAL#)!)

957*795&: ?esult !

8!+ 5.'0

p: 5'3. 5'35=5'.

p: 5'3

pC+2 3. 33=

pC+2 36

p+2 .0 51=10

p+2 .3

)02M 4=4

:C .2 34=4

:b 15' 13'2=15'3

:C+3 14'3 22=24

C+2 20' 23=25

A=aD+2 0'6

+2Ct 20'6

Lactate 3'05

Conclusion% asidosis

respiratori


17/31

"KI!N"(P("A!+N

1' (hyt$ % regular sinu

2' :eart rate % 1.00/ 20% 5.3' A*is % lead ! Av-


18/31

C:") J (A#

nterpretation C


19/31

"C:+CA(D!+I(AP:#


20/31


21/31

ABN+(&AL!# DAAAnamnesis

1' Dyspneu 2' +rthopneu 3' Chest pain le-t

side' eaness and

being lethargic

.' 8ever 6' )$oing

cigarette5' !ncreasing hrist

' Cough

Ph#sical amination

&. Achantosis !igricans &09. blured vision /7/ 90*. )tv HLP


22/31

P(+BL"& L!)1' Congestive :eart 8ailure

2' +vereight

3' "-usi Pleura

' )yo cardiogenic

.' :ipoalbu$ine$ia6' A7ote$ia

5' (+&B)

' :iperurise$ia

!P


23/31

C+NI")!" :"A( 8A!L("

Assesse$ent Diagnosis etiology%

hypertension cardio$yopathy $iocarditis

Diagnosis anato$y%

L:(: Diagnosis -unctional%

N#:A grade 3 O

!P D* P(+ N P(+ BNP

!P * 8ar$acology

8urose$id 20$g 1*1

P+% Bisoprolol )pironolaton

A(B

As' -olat

Non 8ar$acology +2 canule 2= liter/ $enit

)aturasi +2 E40 M

!P &* -eneral Condition

Vital Sign

Che$ical O he$atologi s

!P "*:eart&aint

eigPhys)top


24/31

+"("!I:

Assesse$ent

!P D*

!P * :itung alori Ieneral advice on health

eight and li-e style Consider surgery

!P &* &onitoring eight every

ee

aist circu$-erence !P "*

Diet Lo Calory Diet Lo 8at

!P *


25/31

"8)! PL"(A

Assesse$ent ransudat

esudat

!P D* (ivalta test

!P * )esuai dengan etiologi

ransudat atau esudat

8ar$acology Antibiotics% ce-tria*on 1*1 Bro$he*in hydroclorid $g/2$l

(anitidin .0$g 2*1 A

Non 8ar$acology

pungsi

!P &* Bloodtest

BIA

!P "J Adeuate restat night

aing naps during the day i- needed

(ehidration

8inishing all o- their antibiotic$edications


26/31

)#+K KA(D!+I"N!K

Assesse$ent

&engatasi egaatan

!P D* "CI

!P *

Loading cairan• dobuta$in .$cg/gb

• "pineprin 3A

Non -ar$aology%

+2 possitive pressure 6=

!P &*• ital sign

• "CI

!P "*

Q

!P *


27/31

AR+"&!A

Assesse$ent Chronic idney

disease

Acute renal -ailure

!P D*

)I Abdo$en

8ar$acologic

Non 8ar$acologic Lo protein intae 0'6=0' g/g/day

!P &* rine product Bioi$ia blood e*a$ination rine e*a$ination I8(

10=age *BB /52 *creatinine seru$ *40/52*1'.3 ; 635 L8I nor$al % S40 L8I T $ild % 60=4 L8I T $oderate% 30=.4 L8I T servere % 1.=24 CKD %E1.

Che$ical blood e*

!P "*

Diet lo salt Diet Lo protein


28/31

:#P+ALB&!N"&!A

Assesse$ent

IgIA pre renal )indro$a Ne-roti )irosis hepati

!P D*

Pitting ede$a

!P * 8ar$acology

Albu$in 20M

3.22 *40*0; 5

Non 8ar$acology Diet tinggi protein


29/31

(+&B)

Assesse$ent

&encegah egaatan

!P D*

!P * :eparin 1.0'000/2Ua$< u

heparin> resio perdarahan "no*aparin' AriJtra < lo $

heparin> resio perdarahan ial .000iu/$l * .$l

Non -ar$aology%

Diet lo$ %at D0 " vegetable, pe !P &*

• ital sign

• PAP !P "*

Bed rest


30/31

:!P"((!)"&!A

Assess$ent% =

!P D*

!P *

Allopurinol 100$g 30

Non -ar$aology% Diet lo$ purin

!P &*

• Bioche$ia blood e*post oresi asa$ u

!P "*

Diit lo purin B"N,+


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