Ppt Case Asma Tika

8/16/2019 Ppt Case Asma Tika

http://slidepdf.com/reader/full/ppt-case-asma-tika 1/45

Preceptor:

dr. Ulynar Marpaun

Presenter:

Mainurtika(1102011151

Pediatric DepartmRaden Said Soekanto H

Yarsi Medical Unive

Periode December 21rd – Febr

Case Presentation

Asthma in Pediatric



IDENTITYPATIENT• Name : C.A

• Birth date : July 27th 2009• Age : 7 years old

• Gender : female

• Adresss : Jalan kerja bakti RT 01/04 makassar

• Nationality : Indonesia• Religion : Islam• Date of admission : January 5th 2016• Date of examination : January 7th 2016



ANAMNESIS

The Anamnesis Was Taken On an!ary "rd 2016# By Alloana

m &atient's (other And Grandmother).

*hortness Of Breath

Non &rod!+ti,e Co!gh#

%"ie& complain

'dditional complain



HISTORY OF PRESENT ILLNESS

7 years old !hild !ame to raden said sukanto "ol

ter hos"ital emer#en!y room sufferin# from hard to bre

!e $ hours before admission the hos"ital% ri#ht after sofs !onsum"tion and "layin# &ith friends' (atient)s moth

!om"lainin# !ou#h !ontinuously' *other said that her

ot this disease &hen she &as 1 years old'



-I*TOR O% &R/*/NT I00N/** $1)

+er mothersaid that her!hild #otasthma &henshe &as 1years old'

sufferin#

from hard to breath%!ou#h!ontinuously

,ufferin# fromhard to breath%!ou#h

!ontinuously'



HISTORY OF PAST ILLNESP"aryn(itis )

*ronc"itis -Pnemonia -

Morbili -

Pertssis -

+aricella -

Dip"teria -Malaria -

Polio -

,nteritis -

*acillary dysentry

'moeba dysentryDiarr"ea

."yp"oid

/orms

Sr(ery

*rain concssion

Fractre

Dr( reaction



ALLERGIC HISTORY

• The 2atient ha,e asthma history 3hen she i

s old.

• The 2atient didn't ha,e allergy to medi+ine.

• The 2atient ha,e allergy to d!st# and +old 3



BIRTH HISTORYMOTHER’S PREGNANCY HISTORY

The mother ro!tinely +he+ked her 2regnan+y to the hos

ied any 2ro5lem noted d!ring 2regnan+y.

CHILD’S BIRTH HISTORY• 0a5or : hos2ital•

Birth attendants: do+tor• (ode of deli,ery : 2er,aginam• Gestation : 6 months• Infant state : healthy• Birth 3eight : 1677 grams•

Body lenght : 89 +m



Mental stat

%onclsion #&a'tor and de

status is still int%e nor"al li"appropriate a't%e

patients age

Development History

Psycomotor development• *ead up 1 "ont% old• S"ile 1 "ont%• +aug%ing 1-2 "ont% old• Slant 2,5 "ont%s old• Spee'% initiation 5 "ont% old• Prone podition 5 "ont% old•

Sitting "ont% old• Cra$ling "ont%s old



HISTORY OF EATING

• Breast milk: ex+l!si,ely 4 years.

• %orm!la milk: 5e5ela+

• %r!it and ,egeta5les: +arrots# 5ro+olli# 2a2aya

0mmniatHistory

0mmniati

on

Freency

*epatitis / ti"es

Polio ti"es

C# 1 ti"e

P 5 ti"es

*i3 ti"es

Measles 1 time



FAMILY HISTORY

%ather ha,e food allergi+.

HISTORY OF DISEASE IN OTHER FAMILY MThere is no one li,ing aro!nd their home kno3n for ha,ingn as the 2atient.



SOCIAL AND ECONOMIC HIST

•

&atient li,ed at ho!se 3ith sie 17 m x ; m togethnts.

• There 4 door at the front side#4 toilet near the kit+edrooms# there are 9 3indo3s.

•

-ygieneThe 2atient's mother +hanges his +lothes e,ery

an +lothes.

Bed sheets +hanged e,ery one 3eeks.



PHYSICAL EXAMINATION( JANUARY 5TH 2016

GENERAL STATUS

•General +ondition : +om2os mentis

•A3areness : +om2os mentis

•&!lse : 476 x=min# reg!lar# f!ll# str

•Breathing rate : 8" x=min

•Tem2erat!re : <9#8 7C $2er axila)



'ntropometry /ei("t : 14k(Hei("t :11# cm5tritional stats ba

2###65ational %enter &orStatistic7year 2###/F' 6/ei("t &or '(e

14 8 1! 9 1## ; !< HF' 6Hei("t &or '(e11#8114 91## ; 34/FH 6/ei("t &or '(14 81= 9 1## ; !!

4-#1-2#1$ = years 1! k(14 k(



HEAD TOE EXAMINATION•HEAD

Normo+e2haly# hair $5la+k# normal distri5!tion# not ed) sign of tra!ma $>) large fontanelle o2ened# 2ete+hiae

•EYES

I+teri+ s+lera >=># 2ale +on?!+ti,a >=># la+rimation >=># s!># 2!2ils <mm=<mm isokor# dire+t and indire+t light res2

•EARS

Normal sha2e# no 3o!nd# no 5leeding# se+retion or se

•NOSE

Normal sha2e# midline se2t!m# se+retion >=>



MOUTH•0i2s : moist•(!+o!s : moist•Tong!e: no dirty•Tonsils : T4=T4# no hy2eremia•&harynx : hy2eremia

NEC!•0ym2h node enlargement $>)# s+rof!loderma

Head .oe ,9amination 62



THORAX

•

Ins2e+tion : symetri+ 3hen 5reathing# retra+tio+ordis is not ,isi5le.

•&al2ation : mass $>)# ta+tile fremit!s @=@

•&er+!ssion : sonor so!nd

•A!s+!ltationCor : Reg!lar *4>*1# m!rm!r $>)# gallo2 $>)

&!lmo : esi+!lar @=@# 3heeing @=@ eks2iration# rales >=>

Head .oe ,9amination 6>



ABDOMEN•

I"#$%&')" : +on,ex# e2igastri+ retra+tion $>)# thereening of the ,eins# no s2ider ne,i.

• P*+$*')" : s!22le# li,er and s2leen not 2al2a5le# $>)# a5dominal mass $>)

• P%r&,##)" : the entire field of tym2ani+ a5dome

d!llness $>)• A,#&,+'*')" - normal 5o3el so!nd# 5r!it $>)

Head .oe ,9amination 64



•.ERTEBRA

There does not a22ear s+oliosis# ky2hosis# and lordok any mass along the line of the ,erte5ral

•E!STREMITIES

Warm# 2ete+hiae $>)#2!r2!ra $>)#+a2illary refill time 1 se$>)

•S!INNormal t!rgor

Head .oe ,9amination 6$



NEUROLOGICAL EXAMINAT

MENINGEAL SIGN5c"al ri(idity -

4ernig sign -

+asegue sign -

rudinski 1 -rudinski 2 -



MOTORIC EXAMINATIONPo?er

Hand

Feet

4 4 4 48 4 4 4 4

4 4 4 48 4 4 4 4

.ons

Hand

Feet

!or"otonus 7 !or"oton

!or"otonus 7 !or"oton.rop"y

Hand

Feet

!or"otrop%y 7 !or"otrop

!or"otrop%y 7 !or"otrop



P"ysiolo(ic ReAe9

Upper e9trimities

*iceps

.riceps

Bo?er e9trimities

Patella

'c"illes

) 8 )

) 8 )

) 8 )

) 8 )

Motoric ,9amination 627



MOTORIC EXAMINATION (/

Pat"olo(ic ReAe9

Upper

e9trimities

HoCman

.rommer

Bo?er

e9trimities

*abinsky

%"addock

ppen"eim

Eordon

Sc"aeCer

- 8 -

- 8 -

- 8 -

- 8 -

- 8 -

- 8 -

- 8 -

%lons

Patella

'c"illes

- 8

- 8



De&ecation

Urination

S?eatin(

5ormal 6 1-2 times

5ormal 6 >-4 times

5ormal

Autonom Examination



LABORATORY IN.ESTIGATIONHematolo(y Reslts 5ormal +

*ae"oglo3in 1/,5 1/-1 g7

+euko'ytes 1=$## 5,000 8 10,0

*e"ato'rytes ># 0 8

ro"3o'ytes <4$### 150,000

00,00079

;ryt%ro'ytes ,0< 8 5 "illio



OR!ING DIAGNOSIS

A*T-(A IN &/DIATRIC



MANAGEMENMANAGEMENT IN HOSPIT

•-2 1./*

• 3 $'

•J' -T8* 28600 *

•J' 8*T+,- $ 8 1 *

•*R-8-. $81 T+

•+.T- : T; <

• T-. = >1%25 *?

• ,-.- 10 R-(,

• . 2



PROGNOSIS

•O AD ITA( : DBIA AD BONA

•O AD %NCTIONA( : DBIA AD BO•O AD *ANACTIONA( : DBIA AD

FOLLO UP (05 01 16



FOLLO UP (0501161 Fever 6-7

P"le(m 6)7*reat"less 6)7Prodctive co(" 6)7

#eneral 'ondition Co"pos "entis.*eart rate = 115 >7"in?espiratory rate = /5>7"in

e"perature = /,@CCardio S17S2, reguler, no "ur"ur, no gallopPul"onary esi'uler 7, r%on'%i -7-, $%eeing 7

' Ast%"a ron'%iale

7 ron'%iolitisP - B2 1+7"

− DE 4aen/, , <50'' 7 2 *ours.− nF. Ce&ota>i"e 2>00 "g D− nF. e>a />1 "g D− A"3ro>ol syr / > 1 't%− n%alation &ourt% a day Dentolin G (1,25 "g) isolon

10 drops !aCl 1 ''

FOLLO UP (060116



FOLLO UP (06 01 16S Fever 6-7

P"le(m 6-7*reat"lless 6-7Prodctive co(" 6)7

#eneral 'ondition Co"pos Mentis

*eart rate = 120 >7"in?espiratory rate = /0>7"in

e"perature = /.5@CCardio S17S2, reguler, no "ur"ur, nogallopPul"onary retra'tion () esi'uler 7,r%on'%i -7-, $%eeing 7

' Ast%a ron'%iale7 ron'%iolitis

P - B2 1+7"− DE 4aen/,− nF. Ce&ota>i"e 2>00 "g D− nF. e>a />1 "g D− A"3ro>ol s r / > 1 't%

FOLLO UP (0 01 16



FOLLO UP (00116S Fever 6-7

P"le(m 6-7Prodctive co(" 6-7*reat"less 6-7

#eneral 'ondition Co"pos "entis.*eart rate = 110 >7"in?espiratory rate = /0>7"in

e"perature = /@CCardio S17S2, reguler, no "ur"ur, no gallopPul"onary esi'uler 7, r%on'%i -7-, $%eeing 7

' Ast%"a ron'%iale

7 ron'%iolitis

P − DE ?inger +aktat, , <50'' 7 2 *ours.− nF. Ce&ota>i"e 2>00 "g D− nF. e>a />1 "g D− A"3ro>ol syr / > 1 't%− n%alation t$i'e a day Dentolin G (1,25 "g) isolon 10

drops !aCl 1 ''



ASTHMA IN PEDIATRIC

+;?AU?; ?;D;H





CLASIFICATION -



PATHOPHYSIOLOGY• Imm!nologi+al a5normalities• T>+ell imm!nity.• Ato2y• *tr!+t!reEf!n+tion intera+tions• Air3ay remodeling.• Bron+hial inflammation.• Nasal inflammation.• Role of e2itheli!m.• Inflammatory +ells and their re+r!itment.• Air3ay o5str!+tion.• Air3ay hy2erres2onsi,eness and ne!ral +ontrol.



DIAGNOSIS



Diagnosing asthma in yo!ng +hildren is diffi+!lt 5e+a!n often +o!gh and 3heee 3ith +olds and +hest infe+this is not ne+essarily asthma.

Bron+hiolitis is another ,ery +ommon +a!se of 3heeen.&hysi+al examination• The 2hysi+ian 3ill +ond!+t a 2hysi+al exam and may

e tests E x ray# 5lood tests# allergy skin tests and 2!lm+tion tests $2fts).• -istory: the 2hysi+ian 3ill take a detailed history of:• family allergy= asthma 3ith em2hasis on 2arents• +hild's allergy history> e.G. /+ema• +hild's history of illness to date e.G. %reF!en+y of +o• ' :

DI%%/R/NT DIAGNO*I*



DI%%/R/NT DIAGNO*I*

TREATMENT



TREATMENT

TREATMENT



TREATMENT

• EDUCATIONAsthma ed!+ation sho!ld not 5e regarded as a single e,rather as a +ontin!o!s 2ro+ess# re2eated and s!22lemen

,ery s!5seF!ent +ons!ltation

• TRIGGER A.OIDANCEAsthma sym2toms and exa+er5ations are triggered 5y a of s2e+ifi+ and nons2e+ifi+ stim!li

• PHARMACOTHERAPYThe goal of asthma treatment is +ontrol !sing the least 2medi+ations. Asthma 2harma+othera2y is regarded as +heatment and sho!ld 5e disting!ished from treatment for

xa+er5ations that is dis+!ssed se2arately

'st"ma %linical 5i("t P,+ .reat



'st"maSta(e

%linicalmani&es

5i("tclinicalmani&es

P,+ .reat

nter"itten I1>7Heek I2>7"ont%s

P;D J0 : SAA

MildPersistent

1>7$eek J2>7"ont%s

P;D K 0:

SAAlo$ d

ModeratePersistent

;eryday!eedrelieer

eerydaynteruptdailya'tiity

J1>7$eeks P;D 0 80 :

SAAlo$dosag

+AA

SeerePersistent

;eryday+i"ited

Al$ays P;D I0: SAA%ig%





TA!E HOME MESSAGES

• Asthma management sho!ld 5e holisti+' in+l

all the elements ne+essary to a+hie,e disease ol

• &atient and 2arent ed!+ation

• Identifi+ation and a,oidan+e of triggers

• se of a22ro2riate medi+ation 3ith a 3ell>fo2lan# and reg!lar monitoring.



."ank Yo



REFERENCES

• A*T-(A *OCI/T O% CANADA. A*T-(A IN IN%ANT* AND ONG C-I0DR/

0AB0/ ON -TT&:==WWW.A*T-(A.CA. ACC/**/D: AG*T 16T-

• &A&ADO&0O* N.G# ARAAWA -. CAR0*/N .-# /T A0. INT/RNATIONA0 CN $ICON) &/DIATRIC A*T-(A. /RO&/AN ORNA0 O% A00/RG AND C0INOG. & 6H9>66H. 1741

• (ORRI* (.. A*T-(A C0INICA0 &R/*/NTATION. 174". AAI0AB0/ ON-TT&:==WWW.(/D*CA&/.CO(. ACC/**/D: AG*T 16T-. 174"

http://www.asthma.ca/

http://www.medscape.com/

http://www.medscape.com/

http://www.asthma.ca/

Documents

Ppt Case Asma Tika