Case Pdl Tb Relaps Ppok Hhd

7/25/2019 Case Pdl Tb Relaps Ppok Hhd

1/37

1

Laporan Kasus

SEORANG LAKI-LAKI, TAHUN DATANG DENGAN KELUHAN SESAK

NAFAS YANG BERTAMBAH HEBAT SEJAK 7 HARI SMRS

O!"

Han#$a", S% K!&

L##ana Sur'a Fa(#)a", S% K!&

*!)+#)+#n

&r% A# Apr#ans'a", Sp%*D-K%*s#

DE*ARTEMEN *ENYAKIT DALAM

RUMAH SAKIT MOH% HOESIN *ALEMBANG


2/37

FAKULTAS KEDOKTERAN UNI.ERSITAS SRI/IJAYA01


3/37

HALAMAN PENGESAHAN

Laporan Kasus

Ju&u

SEORANG LAKI-LAKI, TAHUN DATANG DENGAN KELUHAN SESAK

NAFAS YANG BERTAMBAH HEBAT SEJAK 7 HARI SMRS

O!"2

Han#$a", S% K!&

L##ana Sur'a Fa(#)a", S% K!&

T!a" (!r#)a &an s!(u3u# s!+aa# saa" sa(u s'ara( &aa) )!n#4u(#

4!pan#(!raan K#n#4 S!n#or Ba#an I)u *!n'a4#( Daa) Fa4u(as K!&o4(!ran

Un#5!rs#(as Sr#6#3a'a Ru)a" Sa4#( Mo"a))a& Ho!s#n *a!)+an p!r#o&!

S!p(!)+!r 8 09 D!s!)+!r 01

*a!)+an, No5!)+!r 01

&r% A# Apr#ans'a", Sp%*D-K%*s#

:


4/37

KATA PENGANTAR

S!aa pu3# &an s'u4ur 4!pa&a Aa" S/T% 'an (!a" )!#)pa"4an +!r4a(

&an 4arun#a-N'a s!"#na p!nu#s &apa( )!n'!!sa#4an aporan 4asus 'an%

Laporan 4asus#n# )!rupa4an saa" sa(u s'ara( )!n#4u(# u3#an pa&a K!pan#(!raan

K#n#4 S!n#or I)u *!n'a4#( Daa)Fa4u(as K!&o4(!ran Un#5!rs#(as Sr#6#3a'a

RSU* &r% Mo"a))a& Ho!s#n *a!)+an%

*!nu#s )!nu;ap4an +an'a4 (!r#)a 4as#" 4!pa&a &r% R%M D!6#

Anra#n#, Sp%*Ds!a4u p!)+#)+#n &aa) p!nu#sanaporan 4asus #n#, s!r(a

4!pa&a s!)ua p#"a4 'an (!a" )!)+an(u "#na (u#san #n# &apa( s!!sa#4an%

*!nu#s )!n'a&ar# )as#" +an'a4 4!4uranan &aa) p!n'usunan aporan

4asus #n#% O!" 4ar!na #(u, 4r#(#4 &an saran 'an )!)+anun &ar# +!r+aa# p#"a4

sana( p!nu#s "arap4an &!)# p!r+a#4an )asa 'an a4an &a(an% Mu&a"-

)u&a"an (u#san #n# &apa( )!)+!r# #)u &an )an$aa( +a# 'an )!)+a;an'a%

*a!)+an, O4(o+!r 01

*!nu#s


5/37

DAFTAR ISI

Ha

HALAMAN JUDUL%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

#

HALAMAN *ENGESAHAN%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

##

KATA *ENGANTAR%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

###

DAFTAR ISI%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

#5

BAB I *ENDAHULUAN%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

1

BAB II LA*ORAN KASUS%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

BAB IIITINJAUAN *USTAKA%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

11

BAB I.ANALISISI KASUS %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

DAFTAR *USTAKA%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

:0


6/37

BAB I

PENDAHULUAN

*!n'a4#( *aru O+s(ru4(#$ Kron#4 =**OK>, )!rupa4an p!n'a4#( 4ron#4

'an(an&a# &!nan 4!(!r+a(asan a#ran u&ara &aa) sauran napas 'an

(#&a4s!p!nu"n'a r!5!rs#+!% **OK a4"#r-a4"#r #n# )!n3a p!n'a4#( 'an

s!)a4#n)!nar#4 un(u4 +#;ara4an o!" 4ar!na pr!5a!ns# &an an4a

)or(a#(asn'a 'an(!rus )!n#n4a(%1

**OK )!rupa4an p!n'a4#( paru-paru 'an )!n"an;ur4an &an)!ra)pas

4!)a)puan s!oran )anus#a un(u4 +!rna$as%D# A)!r#4a, 4asus 4un3unan pas#!n

**OK #ns(aas# a6a( &arura()!n;apa# an4a 1, 3u(a, 79%000 )!)!ru4an

p!ra6a(an ru)a" sa4#( &an11?%000 )!n#na s!a)a (a"un 000%S!+aa#

p!n'!+a+ 4!)a(#an, **OK)!n&u&u4# p!r#n4a( 4! !)pa( s!(!a" p!n'a4#(

3an(un, 4an4!r &an p!n'a4#(s!r!+ro 5as;uar%B#a'a 'an !uar4an un(u4

p!n'a4#( #n# )!n;apa# @< )#'arp!r (a"unn'a% /HO )!)p!r4#ra4an +a"6a

)!n3!an (a"un 00 pr!5a!ns#**OK a4an )!n#n4a(% A4#+a( s!+aa# p!n'!+a+p!n'a4#( (!rs!r#np!r#n4a(n'a a4an )!n#n4a( &ar# 4!-1 )!n3a 4!- &an

s!+aa# p!n'!+a+4!)a(#an a4an )!n#n4a( &ar# 4!-9 )!n3a 4!-:% B!r&asar4an

sur5!' 4!s!"a(anru)a" (ana D!p% K!s% RI (a"un 1??, **OK +!rsa)a as)a

+ron;"#a )!n&u&u4# p!r#n4a( 4!-9%1

M!n#n4a(n'a us#a "#&up )anus#a &an &apa( a(as#n'a

p!n'a4#(&!!n!ra(#$ a#nn'a )!na4#+a(4an **OK sana( )!nanu 4ua#(as

"#&up us#a an3u(% M!ro4o4 )!rupa4an $a4(or r!s#4o (!rp!n(#n p!n'!+a+ **OKsa)p#n $a4(or r#s#4o a#nn'a s!p!r(# +#&an #n&us(r# 'an (#&a4 &apa(

p#sa"4an &!nan pous# u&ara &an #n4unan%

1


7/37

BAB II

LAPORAN KASUS

%1 IDENTIFIKASI

Na)a 2 Tn% SBA

Us#a 2 97 (a"un

J!n#s K!a)#n 2 La4# a4#

Aa)a( 2 Ko)p!4 M!a" Asr# II Bo4 G No% 1, Ka+% Ban'u As#n

S(a(us 2 M!n#4a"

*!4!r3aan 2 *!ns#unan

*!nan 2 SMA

MRS 2 0 O4(o+!r 01

2.2 ANAMNESIS (AUTOANAMNESIS, 23 Oktober 20! "#k#$ %.00 &'b

Ke$#)*+ #t**

S!sa4 napas +!r(a)+a" +!ra( s!3a4 7 "ar# SMRS

R'&*-*t Per*$*+*+ Pe+-*k't

S!3a4 )#nu SMRS, os )!n!u" s!sa4 na$as% S!sa4 "#an (#)+u,

s!sa4 (#)+u 4!(#4a +!ra4(#$#(as s!p!r(# +!r3aan &ar# 4a)ar 4! (o#!( 'an +!r3ara4 0 )!(!r% S!sa4 (#&a4 p!naru"# ;ua;a &an 6a4(u (!r(!n(u% *as#!n !+#"

n'a)an &u&u4 4!(#4a s!sa4% S!sa4 +!r4uran 3#4a os )!n"#rup o+a( "#sap

B!ro(!;% Na$as +un'# )!n# =->, +a(u4 =>, +!r&a"a4 =>, 6arna pu(#", 4!n(a,

&ara" =->, +an'a4n'a 1 s!n&o4 )a4an (#ap +a(u4% D!)a) =>, (#&a4 (!rau

(#n#, (#)+u pa&a )aa) "ar#, +!r4uran pa&a pa#, &an s#an "ar#% K!r#na(

)aa) =>, na$su )a4an )!nurun =>, p!nurunan +!ra( +a&an => !(a"u# 4ar!na

os s!r#n )!n#)+an +!ra( +a&an s!nr# ru)a"% T!r+anun )aa) "ar# 4ar!na


8/37

s!sa4 =->, os (#&ur &!nan +an(a 'an (!rsusun )!n#n#, os n'a)an (#&ur

)#r#n 4! ara" 4#r#% N'!r# &a&a => pa&a &a&a s!+!a" 4#r#, (#&a4 )!n3aar, n'!r#

s!p!r(# (usu4-(usu4, "#an (#)+u, +!r4uran 3#4a &a&a (!pu4-(!pu4, n'!r# uu

"a(# =->, +!r&!+ar-&!+ar =->, )ua =->, )un(a" =->, s!)+a+ pa&a (un4a# &an

4!opa4 )a(a =->, sa4#( 4!paa =->, )u&a" !a" =>, !)as =>, )a(a +!r4unan-

4unan =->, BAK s!p!r(# +#asa, n'!r# saa( +!r4!)#" =->, 6arna 4un#n 3!rn#", &ara"

=->, +usa =->, pas#r =->, BAB (#&a4 a&a 4!a#nan% Os +!ro+a( 4! IGD RSMH, &an

p!r+o!"4an puan% *as#!n +!r# o+a( KSR, Asa) Tran!Ca)a( &an n!uro&!C%

K!u"an rasa4an +!r4uran%

S!3a4 7 "ar# SMRS, pas#!n )!n!u" s!sa4 &an )a4#n )!)+!ra(% S!sa4

(#)+u 4!(#4a os +!r3aan &ar# (!)pa( (#&ur )!nu3u 4urs# &!nan 3ara4 10 )!(!r,

s!sa4 s!r(a# suara )!n#, s!sa4 +!r4uran 3#4a os )!n"#rup o+a( "#sap B!ro(!;%

T!r+anun )aa) "ar# 4ar!na s!sa4 =->, os (#&ur &!nan +an(a 'an (!rsusun

)!n#n#, os n'a)an (#&ur )#r#n 4! ara" 4#r#% N'!r# &a&a => pa&a &a&a s!+!a"

4#r#% Ba(u4 => &a"a4 => +!r6arna pu(#" 4!4un#nan, &ara" =>, 4ons#s(!ns#

4!n(a, +an'a4n'a 1 s&) s!(#ap 4a# +a(u4% D!)a) => (#n#, )!n## =->,"#an (#)+u, su"u na#4 pa&a )aa) "ar# +!r4uran pa&a pa# &an s#an "ar#,

4!r#na( pa&a )aa) "ar# =->, na$su )a4an )!nurun =>, p!nurunan +!ra( +a&an

=> s!)+a+ pa&a 6a3a" &an 4a4# =->, )ua =->, )un(a" =->, BAB &an BAK (#&a4

a&a 4!a#nan% Os 4!)uan +a6a +!ro+a( 4! IGD RSMH &an ra6a(%

R'&*-*t "e+-*k't /*)#$#

- R#6a'a( sa4#( TB *aru => pa&a (a"un 00?% *as#!n (!a" +!ro+a( &an )#nu)

OAT s!a)a 9 +uan &an n'a(a4an s!)+u" o!" &o4(!r )!au# p!)!r#4saan

BTA =-> &an p!)!r#4saan $o(o ("ora4s% *as#!n +!r# o+a( B!ro(!;, "#sap (#ap

4a# pas#!n )!rasa s!sa4%- R#6a'a( ra6a( ru)a" sa4#( : +uan SMRS 4ar!na a&a ;a#ran paru, (!a"

s!&o( &an ra6a( s!a)a 7 "ar#% D#+!r# o+a( T!op"##n!, A)#nop"##n!, &an

a;!(' ;'s(!n%

-R#6a'a( sa4#( as)a san4a

:


9/37

- R#6a'a( &ara" (#n# => !(a"u# s!3a4 9 (a"un au, pas#!n )#nu) o+a(

(!(ap# (#&a4 (a"u na)a o+a(n'a, o+a( )#nu) (!ra(ur%

R'&*-*t keb'***+

- R#6a'a( )!ro4o4 => +an'a4n'a 10 +a(an "ar#, ro4o4 4r!(!4, s!a)a


10/37


11/37

B!n(u4 o5a s#)!(r#s, !4spr!s# sa4#( s!&an, ra)+u( ron(o4 =->, aop!s#a =->,

&!$or)#(as =->%

M*t*

E4sop"("a)us &an !n&op"("a)us =->, !&!)a pap!+ra =->, 4on3un(#5a

pap!+ra pu;a( =->, s4!ra #4(!r#4 =->, pup# +ua(, #so4or, a)!(!r : )),

r!$!4 ;a"a'a nor)a, p!r!ra4an +oa )a(a 4! s!aa ara" +a#4, apanan

p!n#"a(an uas, 5#sus )!nurun pa&a )a(a 4#r#%

H'/#+1

Ba#an uar (#&a4 a&a 4!a#nan, s!p(u) &!5#as# =->, (uan-(uan &aa)

p!ra+aan +a#4% S!apu( !nr &aa) +a(as nor)a, (#&a4 a&a s!4r!(% T#&a4

(!)u4an p!n'u)+a(an )aupun p!r&ara"an%

Te$'+1*

Top"# =->, n'!r# (!4an pro;!ssus )as(o#&!us =->, s!apu( p!n&!naran (#&a4

a&a 4!a#nan, p!n&!naran +a#4%

M#$#t

B#+#r s#anos#s =->, pu;a( =->,pursed lip breathing =>, s(o)a(#(#s =->, r"aa&!n

=->, pu;a( pa&a #&a" =->, a(rop# pap# #&a" =->, us# (#&a4 a&a "#p!r(ro$# &an

p!r&ara"an, (ons# (#&a4 a&a p!)+!saran, $ar#n "#p!r!)#s =->, +au

p!rna$asan 4"as =->,

Le)er

T#&a4 a&a p!)+!saran 4!!n3ar !(a" +!n#n, (#&a4 a&a p!)+!saran 4!!n3ar

(#ro#&, J.* =0> ;)HO, 4a4u 4u&u4 =->, (u)or =->%

D*/*

B!n(u4 &a&a s#)!(r#s, barrel chest (+), r!(ra4s# nn &a&a =->% Sp#&!r

na!5# =->, s!a #a )!!+ar, su&u( anuus ;os(a! ?0o

P*r#4"*r#

Insp!4s# 2 s(a(#s s#)!(r#s 4anan 4#r# na)#s s#)!(r#s 4anan 4#r#%

*apas# 2 s(!) $r!)#(us )!nurun 4anan 4#r#

*!r4us# 2 "#p!rsonor s!)ua apan paru, +a(as paru "!par

pa&a IS .II, p!ran3a4an 1 s!a #a

9


12/37

Aus4u(as# 2 5!s#4u!r )!!)a" pa&a 4!&ua paru, ron4"# => +asa"

s!&an paru 4#r#, 6"!!#n =->

5*+t#+1

Insp!4s# 2 #;(us ;ors (#&a4 (!r#"a(

*apas# 2 #;(us ;ors (#&a4 (!ra+a

*!r4us# 2 Ba(as 3an(un a(as su#( n#a#

Ba(as 3an(un 4anan #n!a s(!rna#s &!4s(ra

Ba(as 3an(un 4#r# su#( n#a#

Aus4u(as# 2 HR ?9 4a#)!n#(, r!u!r, pusus &!$#s#( =->, +un'#

3an(un I-II )!n3au", Mur)ur =->, Gaop =->

Ab/oe+

Insp!4s# 2 &a(ar, 5!n!4(as# =->, 3ar#nan paru( =->, +!4as op!ras# =->%

*apas# 2 !)as, n'!r# (!4an (#&a4 a&a, "!par &an #!n (a4 (!ra+a

*!r4us# 2 (#)pan# s!uru" +a#an a+&o)!n

Aus4u(as# 2 +#s#n usus nor)a

A$*t Ke$*'+

T#&a4 p!r#4sa

Ektre't*

Sup!r#or 2 *a)ar pu;a( =-->, pa)ar !r#(!) =-->, clubbing finger =-->,

s#anos#s =->, 4o##n#4#a =-->, a4ra n#n =-->, RT &!(#4, ROM

a4(#$ &an pas#$ uas%

In$!r#or 2 E&!)a pr!(#+#a =-->,clubbing finger =-->, 4o##n#4#a =-->, s#anos#s

=->, a4ra n#n =-->,RT &!(#4, ROM a4(#$ &an pas#$ uas%

2.6 PEMERIKSAAN PENUN5ANG

Peer'k**+ L*bor*tor'# (............. 20!

7


13/37

H*'$ Peer'k**+ He*to$o1'7

=%%%%%%%%%%%%%%%%%%%>

H*'$ Peer'k**+ B*kter'o$o1'k7

Ba"an p!)!r#4saan &a"a4 :C =s!6a4(u, pa#, s!6a4(u> =:> pos#(#$

H*'$ Peer'k**+ K#$t#r7

J!n#s +a"an 2 Spu(u)

J!n#s p!)!r#4saan 2 Ku(ur M#4rooran#s)! r!s#s(!ns#

Na)a 4u)an2 1>Klebsiella pneumoniae

Has# )#4ros4op#s2 Gra) =-> +a;# =>

Gra) => ;o;;us =>

L!u4os#( -Acinetobacter baumannii/calcoaceticus

Has# )#4ros4op#s2 Gra) =-> +a;# =>


14/37

Gra) => ;o;;us =>

L!u4os#( -


15/37

Ke*+2TB paru !s# uas

*n!u)on#a

**OK

Fo(o ("oraC A* = 0 No5!)+!r 01>

K!(!ranan%%%%%%%%%%%%%%%%

Fo(o T"ora4 a(!ra =0 No5!)+!r 01>

K!(!ranan%%%%%

Peer'k**+ EKG

Foto........

Ira)a s#nus, a4s#s 4anan, HR100+p), !% * nor)a, *R #n(!r5a 0,0 &!(#4, RS

4o)p!4 0,0 &!(#4, RS .1 1, S .1 R ..9 :, RS R II, III,aF., ST-T ;"an! =->%

Ke*+2 R.H I.DNS (Intraventricular Conduction Delay on !pecific)

S"'roetr' ("*'e+ e$*k#k*+ "eer'k**+ r#t'+, t*"' )*'$ t'/*k /'b*&*

10


16/37

2. D'*1+o' ker*

Kasus 4a)+u" TB paru && MDR TB

*!n'a4#( *aru O+s(ru4(#$ Kron#4 =**OK> !4sas!r+as# &!nan #n$!4s# s!4un&!r

H#p!r(!ns# H!ar( D#s!as! =HHD> FN NYHA III &!nan "#p!r(!ns# on (!rap#

2.; D'*1+o' b*+/'+1

TB *aru 4asus 4a)+u" **OK !4sas!r+as# &!nan #n$!4s# s!4un&!r

;orpu)ona! &!nan "#p!r(!ns# on (!rap#%

2.< Pe+*t*$*k*+**+7

No+*r*ko$o1'

Is(#ra"a(,

O- ()!n#( 5#a nasa ;anu

D#!( 3an(un III

E&u4as# =D#anos#s, p!na(aa4sanaan, $a4(or r#s#4o, ;ara p!nuaran, !(#4a

+a(u4, (!4n#4 r!a4sas# na$as &aa)>%

F*r*ko$o1'( IGD

F*r*ko$o1' ( Ater ...

I.FD D A)#nop"##n a)p (( . C)!n#(

#pro$oCa;#n C 00 ) I.

N a;!(' ;#s(!#n : C 1 (a+!( = Gra)>

A)+roCo s'r 1) : C 1 s!n&o4 (a4ar

.asar(an 1C 0 ) (a+!(

11


17/37

*T 00 ) :C1 =3#4a su"u :7,o>

In3% Furos!)#& 1C 0 ) I.

Re+:*+* Peer'k**+

o AGD

o Sp#ro)!(r#

o E;"o;arora$#

o G!n!p!r(

Pro1+o'7

uo a& 5#(a) 2 Du+#a a& +ona)

uo a& $un;(#ona) 2 Du+#a a& )aa)

uo a& sana(#ona) 2 Du+#a a& )aa)

1


18/37

BAB III

TIN5AUAN PUSTAKA

3. De'+''

Is(#a" p!n'a4#( *aru O+s(ru4(#$ Kron#4 =**OK> a(au "ron#; O+s(ru;(#$

*u)onar' D#s!as! =O*D> (u3u4an un(u4 )!n!!)po44an p!n'a4#(-p!n'a4#(

'an )!)pun'a# !3aa +!rupa (!r"a)+a(n'a arus u&ara p!rnapasan% M!nuru(

"lobal Initiative for Chronic #bstructive $ung Disease =GOLD> 01:, **OK

&!$#n#s#4an s!+aa# p!n'a4#( u)u) 'an &apa( !a" &an o+a(#, (an&a#

o!" 4!(!r+a(asan a#ran u&ara 'an )!n!(ap 'an +#asan'a pror!s#$ &an

+!r4a#(an &!nan r!spons p!ra&anan 'an )!n#n4a( aan na$as &an paru-paru

(!r"a&appar(#4! a(au as-as +!r+a"a'a%:

Is(#a" **OK )ua# !na pa&a a4"#r 1?0an &an p!r)uaan (a"un

1?90an% Masaa" 'an )!n'!+a+4an (!r"a)+a()'a arus u&ara (!rs!+u( +#sa

(!r!(a4 pa&a sauran p!rnapasan )aupun pa&apar!n4#) paru%K!o)po4 p!n'a4#(

'an )as4su& a&aa" Bron4#(#s Kron#4 =)asaa" &aa) sauran p!rnapasan>,

!)$#s!)a =)asaa" &aa) par!n4#)>%A&a +!+!rapa a"# 'an )!na)+a"4an 4!

&aa) 4!o)po4 #n# 'a#(u As)a Bron4#a Kron#4, F#+ros#s K#s(#4 &an

Bron4#!4(as#s% S!;ara o#4a p!n'a4#( as)a +ron4#a s!"arusn'a &apa(

oon4an 4! &aa) oonan arus napas 'an (!r"a)+a(, (!(ap# pa&a

4!n'a(aann'a (#&a4 )asu44an 4! &aa) oonan **OK%

Sua(u 4asus o+s(ru4s# a#ran u&ara !4sp#ras# &apa( oon4an s!+aa#

**OK +#a o+s(ru4s# a#ran u&ara !4sp#ras# (!rs!+u( ;!n&!run pror!s#$%K!&ua

p!n'a4#( (a =+ron4#(#s 4ron#4, !)$#s!)a> "an'a &apa( )asu44an 4! &aa)

4!o)po4 **OK 3#4a 4!para"an p!n'a4#(n'a (!a" +!ran3u( &an o+s(ru4s#n'a

+!rs#$a( pror!s#$% *a&a $as! a6a, 4!&ua p!n'a4#( #n# +!u) &apa( a+un4an 4!

&aa) **OK%

11


19/37

Ga)+ar 1% Ga)+aran Bron4us *a&a *!n&!r#(a **OK

J#4a a4u4an p!)!r#4saan pa(oo#4 pa&a pas#!n 'an )!naa)#

o+s(ru4s# sauran napas, aonos#s pa(oo#4n'a (!rn'a(a s!r#n +!r+!&a sa(u

sa)a a#n% D#anos#s pa(oo#4 (!rs!+u( &apa( +!rupa !)$#s!)a s!+!sar 9,

+ron4#(#s 99, s!&an4an +ron4#o#(#s s!+!sar


20/37

Ga)+ar % *aru-paru nor)a &an p!n&!r#(a **OK

*a(o$#s#oo# (!r3an'a o+s(ru4s# a&aa" 4ar!na (!r3an'a p!ra&anan

pa&a sauran p!rnapasan 4!;#%*a&a **OK 'an s(a+#, ;#r# p!ra&anan 'an

&o)#nan a&aa" +an'a4n'a s! n!u(ro$##4 'an (ar#4 o!" In(!r L!u4#n-

%/aaupun 3u)a" #)$os#( 3ua )!n#n4a(, na)un 'an )!n#n4a( "an'a s! T

D "!p!r (#p! 1%B!r+!&a pa&a as)a, 'an &o)#nan a&aa" !os#no$#, s! )as(,

&an s! T D< "!p!r (#p! %K!(#4a (!r3a !4sas!r+as# a4u( pa&a **OK )a4a

3u)a" !os#no$# )!n#n4a( (#a puu" 4a# #pa(%*!r+!&aan 3!n#s s!

'an)!n#n$#((ras# #n#a" 'an )!n'!+a+4an p!ru+a"an r!spon (!r"a&ap

p!no+a(an 4or(#4os(!ro#&% *!nurunan FE.1 p!r(a"un pa&a **OK a&aa" an(ara

0-70 )L&!(#4, 3#4a a4"#rn'a FE.1 )!n3a +a6a" 1 #(!r )a4a an4a

4!sa4#(ann'a )!n;apa# 10%

*!n'a4#( paru o+s(ru4s# 4ron#4 s!r#n a#(4an &!nan !3aa

!4sas!r+as# a4u(% *as#!n **OK a(a4an )!naa)# !4sas!r+as# a4u( +#a 4ons#pas#!n )!naa)# p!r+uru4an 'an +!rs#$a( a4u( &ar# 4ons# s!+!u)n'a 'an

s(a+# &an &!nan 5ar#as# !3aa "ar#an nor)a s!"#na pas#!n )!)!ru4an

p!ru+a"an p!no+a(an 'an su&a" +#asa una4an%1

3.2 E"'/e'o$o1'

*a&a s(u popuas# Inr#s s!a)a


21/37

#n#, "an'a Sur5!# K!s!"a(an Ru)a" Tana D!p4!s RI 1?? )!n'!+u(4an +a"6a

**OK +!rsa)a-sa)a &!nan as)a +ron4"#a )!n&u&u4# p!r#n4a( 4!-9&ar#

p!n'!+a+ 4!)a(#an (!r+an'a4 In&on!s#a%

3.3 Et'o$o1'

*as#!n **OK a(a4an )!naa)# !4sas!r+as# a4u( +#a 4ons# pas#!n

)!naa)# p!r+uru4an 'an +!rs#$a( a4u( &ar# 4ons# s!+!u)n'a 'an s(a+# &an

&!nan 5ar#as# !3aa "ar#an nor)a s!"#na pas#!n )!)!ru4an p!ru+a"an

p!no+a(an 'an su&a" +#asa una4an%E4sas!r+as# a4u( #n# +#asan'a s!+a+4an

o!" #n$!4s# =+a4(!r# a(au 5#rus>, +ron4ospas)!, pous# u&ara a(au o+a( oonan

s!&a(#$%S!4#(ar s!p!r(#a p!n'!+a+ !4sas!r+as# a4u( #n# (#&a4 !(a"u#% *as#!n

'an )!naa)# !4sas!r+as# a4u( &apa( (an&a# &!nan !3aa 'an 4"as s!p!r(#

s!sa4 na$as =spn!a> 'an s!)a4#n +!r(a)+a", +a(u4 pro&u4(#$ &!nan p!ru+a"an

5ou)! a(au puru!ns# spu(u) a(au &apa( 3ua )!)+!r#4an !3aa 'an (#&a4 4"as

s!p!r(# )aa#s!, $a(#u! &an anuan susa" (#&ur% G!3aa 4#n#s **OK !4sas!r+as#

a4u( (!r+a# )!n3a !3aa r!sp#ras# 'a#(u +!rupa s!sa4 na$as 'an s!)a4#n+!(a)+a" +!ra(, p!n#n4a(an 5ou)! &an puru!ns# spu(u), +a(u4 'an s!)a4#n

s!r#n &an na$as 'an &an4a &an ;!pa(% G!3aa s#s(!)#4 (an&a# &!nan

p!n#n4a(an su"u (u+u", p!n#n4a(an &!n'u( na s!r(a anuan s(a(us )!n(a

pas#!n%1

In$!4s# sauran p!rna$asan a&aa" p!n'!+a+ pa#n u)u) &ar#

!4sas!r+as# **OK% Na)un, pous# u&ara, aa 3an(un, !)+o# pu)ona, #n$!4s#

nonpu)ona, &an pn!u)o("oraC &apa( )!)#;u !4sas!r+as# a4u(% T!r&apa( +u4(#

'an )!nun3u44an +a"6a s!(#&a4n'a 0 &ar# **OK !4sas!r+as# s!+a+4an

o!" #n$!4s#% In$!4s# (!rs!+u(


22/37

Fa4(or r#s#4o p!n'a4#( paru o+s(ru4(#$ =**OK> a&aa" "a-"a 'an

+!r"u+unan &an a(au 'an )!)p!naru"# a(au )!n'!+a+4an (!r3an'a **OK

pa&a s!s!oran a(au 4!o)po4 (!r(!n(u%

Fa4(or r#s#4o (!rs!+u( )!#pu(# 2 a% Fa4(or p!3a)u (host), +% Fa4(or

p!r#a4u =4!+#asaan )!ro4o4>, ;% Fa4(or #n4unan =pous# u&ara>%1

*. F*ktor "e*# (host)

Fa4(or p!3a)u (host) )!#pu(# !n!(#4 "#p!r r!spons#$ napas &an

p!r(u)+u"an paru%Fa4(or !n!(#4 'an u(a)a a&aa" 4urann'a alfa %

antitripsin 'a#(u s!r#n pro(!as! #n"#+#(or% H#p!r!spons#$ 3aan napas 3ua

&apa( (!r3a a4#+a( pa3anan asap ro4o4 a(au pous#% *!r(u)+u"an paru

a#(4an &!nan )asa 4!"a)#an, +!ra( a"#r &an pa3anan s!)asa ana4-

ana4% *!nurunan $uns# paru a4#+a( anuan p!r(u)+u"an paru &ua

+!r4a#(an &!nan r#s#4o )!n&apa(4an **OK%9

b. Per'$*k# (keb'***+ Merokok

Asap ro4o4 )!rupa4an $a4(or r#s#4o (!rp!n(#n (!r3an'a **OK%

*r!5a!ns# (!r(#n# (!r3an'a anuan r!sp#ras# &an p!nurunan $aa

paru a&aa" pa&a p!ro4o4 us#a )ua# )!ro4o4, 3u)a" +un4us p!r(a"un

&an p!ro4o4 a4(#$ +!r"u+unan &!nan an4a 4!)a(#an% T#&a4 s!uru"

p!ro4o4 )!n3a **OK, "a #n# )un4#n +!r"u+unan &!nan$a4(or

!n!(#4% *!ro4o4 pas#$ &an )!ro4o4 s!a)a "a)# 3ua )!rupa4an $a4(or

r#s#4o **OK%9

:. F*ktor L'+1k#+1*+ ("o$#' #/*r*

*ous# u&ara (!rr# &ar# pous# &aa) ruanan = indoor> s!p!r(# asap ro4o4,

asap 4o)por, asap 4a'u +a4ar, &an a#n-a#n s!&an4an pous# uar ruanan

=outdoor> s!p!r(# as +uan #n&us(r#, as +uan 4!n&araan +!r)o(or, &!+u

3aanan, &an a#n-a#n, s!r(a pous# (!)pa( 4!r3a, s!p!r(# +a"an 4#)#a, &!+ua(

#r#(as# &an as +!ra;un% *a3anan 'an (!rus )!n!rus o!" pous# u&ara

)!rupa4an $a4(or r#s#4o a#n **OK% *!ran pous# uar ruanan =outdoor

polution> )as#" +!u) 3!as (ap# !+#" 4!;# +ann4an asap ro4o4% *ous#

&aa) ruanan =indoor polution> 'an s!+a+4an o!" +a"an +a4ar +#o)assa

1


23/37

'an una4an un(u4 4!p!ruan ru)a" (ana )!rupa4an $a4(or r#s#4o

a#nn'a%9

3.! K$*''k*'

B!r&asar4an "lobal Initiative for Chronic #bstruction $ung Disease

=GOLD>, **OK +a# a(as < &!ra3a( 'a#(u 2

*a&a pas#!n &!nan FE.1F. 0,70 2

GOLD 1 2 R#nan FE.1P 0 pr!s#GOLD 2 S!&an 0 Q FE.1 0 pr!s#

GOLD :2 B!ra( :0 Q FE.10 pr!s#

GOLD < 2 Sana( B!ra( FE.1 :0 pr!s#

3. P*to''o$o1'

Sauran napas &an paru +!r$uns# un(u4 pros!s r!sp#ras# 'a#(u p!na)+#an

o4s#!n un(u4 4!p!ruan )!(a+o#s)! &an p!n!uaran 4ar+ono4s#&a &an a#r

s!+aa# "as# )!(a+o#s)!% *ros!s #n# (!rr# &ar# (#a (a"ap, 'a#(u 5!n(#as#, $us#

&an p!r$us#% .!n(#as# a&aa" pros!s )asu4 &an 4!uarn'a u&ara &ar# &aa) paru%

D#$us# a&aa" p!r#s(#6a p!r(u4aran as an(ara a5!ous &an p!)+uu" &ara",

s!&an4an p!r$us# a&aa" s(r#+us# &ara" 'an su&a" (!ro4s#!nas#% Ganuan

5!n(#as# (!rr# &ar# anuan r!s(r#4s# 'a#(u anuan p!n!)+anan paru s!r(a

anuan o+s(ru4s# +!rupa p!ra)+a(an a#ran u&ara sauran napas%7

Fa4(or r#s#4o u(a)a &ar# **OK a&aa" )!ro4o4% Ko)pon!n-4o)pon!n asap

ro4o4 )!ransan p!ru+a"an pa&a s!-s! p!n"as# )u4us +ron4us% S!a#n #(u,

s##a 'an )!ap#s# +ron4us )!naa)# 4!u)pu"an a(au s$uns#ona s!r(a

)!(apas#a%*!ru+a"an-p!ru+a"an pa&a s!-s! p!n"as# )u4us &an s##a #n#

)!nanu s#s(!) !s4aa(or )u4os##ar#s &an )!n'!+a+4an p!nu)pu4an )u4us

4!n(a &aa) 3u)a" +!sar &an su#( !uar4an &ar# sauran napas%Mu4us

+!r$uns# s!+aa# (!)pa( p!rs!)a#an )#4rooran#s)! p!n'!+a+ #n$!4s# &an

)!n3a sana( puru!n%T#)+u p!ra&anan 'an )!n'!+a+4an !&!)a 3ar#nan%

19


24/37

*ros!s 5!n(#as# (!ru(a)a !4sp#ras# (!r"a)+a(% T#)+u "#p!r4apn#a a4#+a( &ar#

!4sp#ras# 'an )!)an3an &an su#( a4u4an a4#+a( )u4us 'an 4!n(a &an

a&an'a p!ra&anan%:

Ko)pon!n-4o)pon!n asap ro4o4 3ua )!ransan (!r3an'a p!ra&anan

4ron#4 pa&a paru% M!a(or-)!a(or p!ra&anan s!;ara pror!s#$ )!rusa4

s(ru4(ur-s(ru4(ur p!nun3an paru%A4#+a( "#ann'a !as(#s#(as sauran u&ara &an

4oapsn'a a5!ous, )a4a 5!n(#as# +!r4uran%Sauran u&ara 4oaps (!ru(a)a pa&a

!4sp#ras# 4ar!na !4sp#ras# nor)a (!r3a a4#+a( p!n!)p#san =r!;o#> paru s!;ara

pas#$ s!(!a" #nsp#ras#% D!nan &!)#4#an, apa+#a (#&a4 (!r3a r!;o# pas#$, )a4a

u&ara a4an (!rp!ran4ap &aa) paru &an sauran u&ara 4oaps%:

O+s(ru4s# sauran napas pa&a **OK +!rs#$a( #r!5!rs#+! &an (!r3a 4ar!na

p!ru+a"an s(ru4(ura pa&asauran napas 4!;# 'a#(u 2 #n$a)as#, $#+ros#s, )!(apas#

s! o+!( &an "#p!r(rop# o(o( poos p!n'!+a+u(a)a o+s(ru4s# 3aan napas%

Ko+e" "*to1e+e' PPOK

Perbe/**+ P*to1e+e' A* /*+ PPOK

17


25/37

3.; D'*1+o'

Daa) )!nanos#s **OK )ua# &ar# ana)n!s#s, p!)!r#4saan $#s#4,

&an p!)!r#4saan p!nun3an =$o(o (ora4s, sp#ro)!(r# &an a#n-a#n>% D#anos#s

+!r&sara4an ana)n!s#s, p!)!r#4saan $#s#4 &an $o(o (ora4s &apa( )!n!n(u4an

**OK 4#n#s% Apa+#a an3u(4an &!nan p!)!r#4saan sp#ro)!(r# a4an &apa(

)!n!n(u4an anos#s **OK s!sua# &!ra3a( =**OK r#nan, **OK s!&an, &an

**OK +!ra(>% D#anos#s **OK 4#n#s (!a44an apa+#a 2

1% Ana)n!s#s

a% A&a $a4(or r#s#4o 2

- Us#a =p!r(!na"an>

- R#6a'a( pa3anan =asap ro4o4, pous# u&ara, pous# (!)pa( 4!r3a>

+% G!3aa

G!3aa **OK (!ru(a)a +!r4a#(an &!nan r!sp#ras#% K!u"an r!sp#ras# #n#"arus p!r#4sa &!nan (!#(# 4ar!na s!r#n4a# anap s!+aa# !3aa

'an +#asa (!r3a pa&a pros!s p!nuaan%

- Ba(u4 Kron#4

Ba(u4 4ron#4 a&aa" +a(u4 'an "#an (#)+u s!a)a : +uan 'an

(#&a4 "#an &!nan p!no+a(an 'an +!r#4an%

- B!r&a"a4 Kron#4

1


26/37

Ka&an-4a&an pas#!n )!n'a(a4an "an'a +!r&a"a4 (!rus )!n!rus

(anpa s!r(a# +a(u4%

- S!sa4 na$as (!ru(a)a pa&a saa( )!a4u4an a4(#5#(as%

S!r#n4a# pas#!n su&a" )!naa)# a&ap(as# &!nan s!sa4 na$as 'an

+!rs#$a( pror!s#$ a)+a( s!"#na s!sa4 #n# (#&a4 !u"4an%

Ana)n!s#s "arus a4u4an &!nan (!#(# una u4uran s!sa4 napas

s!sua# s4aa s!sa4%9

%*!)!r#4saan F#s#4*a&a p!)!r#4saan $#s#4 s!r#n4a# (#&a4 (!)u4an 4!a#nan 'an 3!as

(!ru(a)a aus4u(as# pa&a **OK r#nan, 4ar!na su&a" )ua# (!r&apa(

"#p!r#n$as# a5!o#% S!&an4an **OK &!ra3a( s!&an &an **OK &!ra3a(

+!ra( s!r#n4a# (!r#"a( p!ru+a"an ;ara +!rnapas a(au p!ru+a"an +!n(u4

ana(o)# (ora4s% S!;ara u)u) pa&a p!)!r#4saan $#s#4 &apa( (!)u4an "a-

"a s!+aa# +!r#4u( 2

a% Insp!4s#

- B!n(u4 &a&a barrel chest =&a&a s!p!r(# (on>

- T!r&apa( ;ara +!rnapaspurse lips bretahing =s!p!r(# oran )!n#up>

- T!r#"a( p!nunaan &an "#p!r(ro$# =p!)+!saran> o(o( +an(u na$as%

- *!!+aran s!a #a%

+% *apas#

- Fr!)#(us )!!)a"

;% *!r4us#

- H#p!rsonor&% Aus4u(as#

- Suara na$as 5!s#4u!r )!!)a" a(au nor)a

- E4sp#ras# )!)an3an

- M!n# =+#asan'a (#)+u pa&a !4sas!r+as#>

- Ron4#

:% *!)!r#4saan *!nun3an

*!)!r#4saan p!nun3an 'an p!ru4an pa&a anos#s **OK an(ara a#n 2

1?


27/37

- Raoo# =$o(o ("ora4s>

- Sp#ro)!(r#

- La+ora(or#u) &ara" ru(#n =(#)+un'a po#s#(!)#a )!nun3u44an (!a"

(!r3a "#po4s#a 4ron#4>

- Ana#sa as &ara"

- M#4ro+#oo# spu(u) =p!ru4an un(u4 p!)##""an an(#+#o(#4 +#a

(!r3a !4sas!r+as#>

M!s4#pun 4a&an-4a&an "as# p)!r#4saan raoo#s )as#"

nor)a pa&a **OK r#nan (!(ap# p!)r#4saan raoo#s #n# +!r$uns# 3ua

un(u4 )!n'#n4#r4an anos#s p!n'a4#( paru a#nn'a a(au )!n'#n4#r4an

anos#s +ann &an 4!u"an pas#!n%

Has# p!)!r#4saan raoo#s &apa( +!rupa 4!a#nan 2

- *aru "#p!r#n$as# a(au "#p!rus!n

- D#a$ra)a &a(ar

- ora4an +ron4o5as4uar )!n#n4a(

- Bua

- Jan(un p!n&uu)

D#n'a(a4an **OK =s!;ara 4#n#s> apa+#a s!4uran-4urann'a pa&a

ana)n!s#s (!)u4an a&an'a r#6a'a( pa3anan $a4(or r!s#4o s!r(a# +a(u4

4ron#4 &an +!r&a"a4 &!nan s!sa4 na$as (!ru(a)a saa( )!a4u4an a4(#5#(as

pa&a s!s!oran 'an +!rus#a p!r(!na"an a(au 'an !+#" (ua%9

3.


28/37

:> M!na(as# +ron4ospas)!

M!)+!ran(as #n$!4s#

> *!nananan (!r"a&ap 4o)p#4as#

9> F#s#o(!rap#, (!rap# #n"aas# &an r!"a+##(as#%

*a&a as)a &an **OK, sua(u s!ranan a4u( a(au !4sas!r+as# a4u(

)!)!ru4an p!na(aa4sanaan 'an (!pa( aar o+s(ru4s# 'an (!r3a &apa(

a(as# s!op(#)a )un4#n s!"#na r#s#4o 4o)p#4as# &an p!r+uru4an

p!n'a4#( &apa( "#n&ar# s!&apa( )un4#n% *a&a o+s(ru4s# 4ron#4 'an

(!r&apa( pa&a **OK &an SO*T p!na(aa4sanaan +!r(u3uan un(u4)!)p!ra)+a( pros!s p!r+uru4an $aa paru &!nan )!n"#n&ar#

!4sas!r+as# a4u( &an $a4(or-$a4(or 'an )!)p!r+uru4 p!n'a4#(% *a&a

p!n&!r#(a **OK p!nurunan $aa paru !+#" +!sar +ann4an oran

nor)a% *!n!#(#an RSU* *!rsa"a+a(an )!nun3u44an +a"6a n#a#

5ou)! !4sp#ras# pa4sa &!(#4 p!r(a)a =.E*1> pa&a p!n&!r#(a **OK

)!nurun s!+!sar ) s!(#ap (a"unn'a

*!na(aa4sanaan p!n'a4#( paru o+s(ru4s# s!;ara u)u) (!rr# &ar#

2I% *!na(aa4sanaan u)u)

II% *!)+!r#an o+a(-o+a(an

III% T!rap# o4s#!n

I.% R!"a+##(as#

*. Pe+*t*$*k*+**+ U#

T!r)asu4 &aa) p!na(aa4sanaan u)u) #n# a&aIa" 2

1> *!nan (!r"a&ap p!n&!r#(a &an 4!uara%

M!r!4a "!n&a4a" )!n!(a"u# p!n'a4#(n'a, 'an )!#pu(# +!ra(

p!n'a4#(, $a4(or- $a4(or 'an &apa( )!n;!(us4an !4sas!r+as# s!r(a $a4(or

'an +#sa )!)p!r+uru4 p!n'a4#(%*!ru p!ranan a4(#$ p!n&!r#(a un(u4

usa"a p!n;!a"an &an p!no+a(an%

> M!n"#n&ar# ro4o4 &an a(-a( #n"aas# 'an +!rs#$a( #r#(as#%

Ro4o4 )!rupa4an $a4(or u(a)a 'an &apa( )!)p!r+uru4 p!r3aanan

p!n'a4#(% *!n&!r#(a "arus +!r"!n(# )!ro4o4% D# sa)p#n #(u a(-a(

1


29/37

#n"aas# 'an +!rs#$a( #r#(as# "arus "#n&ar#, 4ar!na a( #(u 3ua &apa(

)!n#)+u4an !4sas!r+as#)!)p!r+uru4 p!r3aanan p!n'a4#(%

:> M!n"#n&ar# #n$!4s# sauran napas

In$!4s# sauran na$as s!&apa( )un4#n "#n&ar# o!" 4ar!na &apa(

)!n#)+u4an sua(u !4sas!r+as# a4u( p!n'a4#(%

L#n4unan s!"a(%

*!ru+a"an ;ua;a 'an )!n&a&a4, u&ara (!rau panas a(au n#n &apa(

)!n#n4a(4an pro&u4s# spu(u) &an o+s(ru4s# sauran napas% T!)pa(

4!(#n#an &!nan 4a&ar o4s#!n r!n&a" &apa( )!nurun4an (!4anan

o4s#!n &aa) ar(!r#% *a&a p!n&!r#(a **OK (!r3an'a "#p!r(!ns#

pu)ona &an 4or pu)ona! &apa( p!ra)+a( +#a p!n&!r#(a p#n&a" &ar#

&a(aran (#n# 4! (!)pa( p!r)u4aan au(%

> M!n;u4up4an 4!+u(u"an ;a#ran%

Ha #n# p!n(#n un(u4 )!n!n;!r4an spu(u) s!"#na )u&a"

!uar4an% *a&a 4!a&aan &!4o)p!sas# 4ors, p!)a4a#an

4or(#4os(!ro#& &an "#pona(r!)# )!)p!r+!sar 4!)un4#nan (!r3an'a

4!!+#"an ;a#ran%

9> Nu(r#!n 'an ;u4up%

*!)+!r#an )a4anan 'an ;u4up p!ru p!r(a"an4an o!" 4ar!na

p!n&!r#(a s!r#n )!naa)# anor!4s#a o!" 4ar!na s!sa4 napas, &an

p!)a4a#an o+a( -o+a(an 'an )!n#)+u4an rasa )ua%

b. Peber'*+ Ob*t4Ob*t*+

1% Bron4oa(or

Bron4oa(or )!rupa4an o+a( u(a)a un(u4 )!na(as# a(au

)!nuran# o+s(ru4s# sauran napas 'an (!r&apa( pa&a p!n'a4#( paru

o+s(ru4s#% A&a : oonan +ron4oa(or u(a)a 'a#(u oonan

s#)pa(o)#)!(#4, oonan an(#4o#n!r#4 &an oonan Can("#n, 4! (#a o+a(

#n# )!)pun'a# ;ara 4!r3a 'an +!r+!&a &aa) )!na(as# o+s(ru4s# sauran

napas% Daa) o(o( sauran napas p!rsara$an ansun s#)pa(o)!(#4 "an'a


30/37

s!#( )!s4#pun +an'a4 (!r&apa( a&!nor!s!p(or +!(a &aa) o(o(poos

+ron4us, r!s!p(or #n# (!ru(a)a a&aa" +!(a-% *!)+!r#an +!(a aon#s

)!n#)+u4an +ron4oa(as#% R!s!p(or +!(a +!r"u+unan !ra( &!nan

a&!n#s#4as!, 'a#(u su+s(ans# p!n(#n 'an )!n"as#4an s#4#4 AM* 'an

)!n'!+a+4an +ron4oa(as#% *!rsara$an +ron4us +!rasa &an s#s(!)

paras#)pa(#s )!au# n!r5us 5aus *a&a as)a a4(#$#(as r!$!4s 5aa

anap s!+aa# 4o)pon!n u(a)a +ron4o4ons(r#4s# (!(ap# p!ranan 5aus

'an pas(# (#&a4 !(a"u#% Su+s(ans# p!n"an(ar sara$ (!rs!+u( a&aa"

as!(#4o#n 'an &apa( )!n#)+u4an +ron4o4ons(n#4s#% A(rop#n a&aa" a(

an(aon#s 4o)p!(#(#$ &an as!(#4o#n &an &apa( )!n#)+u4an r!a4sas# o(o(

poos +ron4us s!"#na (#)+u +ron4oa(as#% O+a( oonan Can("#n

+!4!r3a s!+aa# +ron4oa(or )!au# )!4an#s)! 'an +!u) !(a"u#

&!nan 3!as%

B!+!rapa )!4an#s)! 'an &ua )!n'!+a+4an (!r3an'a +ron4oa(or

a&aa" 2

Bo4a&! r!s!p(or a&!nos#n

Ransanan p!!pasan 4a(!4oa)#n !n&o!n

M!n#n4a(4an 3u)a" &an !$!4(#5#(as s! T supr!sor

M!n#n4a(4an a)+#an 4as#u) 4! &aa) s! o(o( poos &an

p!n"a)+a(an p!n!pasan )!a(or &an s! mast%

+ron4oa(as# 3ua )!n#)+u4an (a4#4ar &an pap#(as# p!)a4a#an

o+a(-o+a( 'an s!!4(#$ (!r"a&ap r!s!p(or +!(a )!nuran# !$!4 sa)p#n #n#%

Goonan aon#s +!(a- 'an anap s!!4(#$ an(ara a#n a&aa" (!r+u(a#n,

$!n!(!ro, sa+u(a)o, ors#pr!na#n &an sa)!(!ro% D# sa)p#n +!rs#$a(

s!+aa# +ron4oa(or, +#a +!r#4an s!;ara #n"aas# &apa( )!)o+##sas#

!nr% *!)+!r#an +!(a- &apa( )!n#)+u4an (r!)or (!(ap# +#a (!rus

+!r#4an )a4a !3aa a4an +!r4uran% *!)+!r#an sa+u(a)o !pas a)+a(

3ua &apa( +!r#4an% *a&a p!n&!r#(a as)a o+a( #n# )un4#n +#sa

)!nuran# (#)+un'a s!ranan as)a )aa)% Dos#s sa+u(a)o !pas

:


31/37

a)+a( C < ) )!)pun'a# )an$aa( 'an sa)a &!nan &os#s C )

&!nan !$!4 sa)p#n 'an !+#" )#n#)a1%

An(#4o#n!r#4 s!p!r(# #pra(rop#u) +ro)#&! )!rupa4an +ron4oa(or

u(a)a pa&a **OK, 4an!na pa&a **OK o+s(ru4s# sauran napas 'an (!r3a

!+#" &o)#nan s!+a+4an o!" 4o)pon!n 5aa% Ko)+#nas# o+a(

an(#4o#n!r#4 &!nan oonan +ron4oa(or a#n s!p!r(# aon#s +!(a- &an

Can("#n )!)+!r#4an !$!4 +ron4oa(as# 'an !+#" +a#4, s!"#na &os#s

&apa( (urun4an s!"#na !$!4 sa)p#n 3ua )!n3a s!#(% *a&a

p!n&!r#(a as)a a4u( p!)+!r#an an(#4o#n!r#4 (#&a4 r!4o)!n&as#4an o!"4ar!na !$!4n'a !+#" r!n&a" +ann4an oonan aon#s +!(a- (!(ap#

p!na)+a"an o+a( an(#4o#n!r#4 &apa( )!n#n4a(4an !$!4 +ron4oa(as#%

*a&a as)a 4ron#4 an(#4o#n!r#4 ;u4up a)an,+ron4oa(as# (!r3a )!au#

+o4a&! r!s!p(or )us4an#n#4 non sp!s#$#4% M!s4#pun !$!4n'a 4uran &ar#

on#s +!(a- (ap# p!na)+a"an o+a( #n# )!)+!r#4an !$!4 (a)+a"an (!ru(a)a

pa&a p!n&!r#(a as)a 'an !+#" (ua% Goonan Can("#n )!)pun'a# !$!4

+ron4oa(or 'an !+#" r!n&a", s!a#n +!rs#$a( +ron4oa(or o+a( #n# 3ua

+!rp!ran &aa) )!n#n4a(4an 4!4ua(an o(o( a$ra)a% *a&a p!n&!r#(a

!)$#s!)a &an +ron4#(#s 4ron#4 )!(a+o#s)! o+a( oonan Can("#n #n#

p!naru"# o!" $a4(or u#)ur, )!ro4o4, aa 3an(un, #n$!4s# +a4(!r# &an

p!nunaan o+a( s#)!(#n &an !#(ro)#s#n% O!" 4ar!na #(u p!nunaan o+a(

Can("#n pa&a **OK )!)+u(u"4an p!)an(auan 'an 4!(a(% *!)+!r#an

+ron4oa(or s!;ara #n"aas# sana( an3ur4an- o!" 4an!na ;ara #n#

)!)+!r#4an +!r+aa# 4!un(unan 'a#(u 2

O+a( +!4!r3a ansun pa&a sauran napas

Ons!( 4!r3a 'an ;!pa(

Dos#s o+a( 'an 4!;#

E$!4 sa)p#n 'an )#n#)a 4ar!na 4a&ar o+a( &aa) &ara" r!n&a"

M!)+an(u )o+##sas# !nr%

A&a +!r+aa# ;ara p!)+!r#an o+a( #n"aas# 'a#(u &!nan #n"aas# &os#s

(!ru4ur, aa( +an(u spacer, nebuhaler, turbuhaler,dischaler, rotahaler &an

nebuliser% Ha 'an p!ru p!r"a(#4an a&aa" ;ara p!)a4a#an 'an (!pa(


32/37

&an +!nar s!"#na o+a( &apa( )!n;apa# sauran napas &!nan &os#s 'an

;u4up%*a&a oran (ua &an ana4-ana4 s!r(a pa&a sua(u s!ranan a4u( 'an

+!ra( )un4#n o+a( (#&a4 +#sa "#sap &!nan +a#4 s!"#na su4ar

)!n&apa(4an +ron4oa(as# 'an op(#)a pa&a p!)a4a#an #n"aas# &os#s

(!ru4ur% *!)+!r#an #n"aas# $!no(!ro 1 ) 4ons!n(ras# 0,1 &!nan

n!+u#s!r pa&a s!ranan as)a )!)+!r#4an p!r+a#4an $aa paru 'an sana(

+!r)a4na pa&a : p!n&!r#(a as)a 'an +!ro+a( 4! po# As)a RSU*

*!rsa"a+a(an (!(ap# pa&a 1? oran p!n&!r#(a **OK &!nan !4sas!r+as#

a4u(, #n"aas# #n# )!)+!r#4an p!r+a#4an su+3!4(#$ s!&an4an p!n#n4a(an

$aa paru (#&a4 +!r)a4na%

*a&a p!n&!r#(a **OK p!)+!r#an +ron4oa(or "arus s!au o+a,

)!s4#pun (#&a4 (!r&apa( p!r+a#4an $aa paru% Apa+#a s!a)a 8: +uan

p!)+!r#an o+a( (#&a4 (!r#"a( p!ru+a"an s!;ara o+3!4(#$ )aupun s!;ara

su+3!4(#$ )a4a (#&a4a" (!pa( un(u4 )!n!rus4an p!)+!r#an o+a(% T!(ap#

p!)+!r#an +ron4oa(or (!(ap #nas#4an pa&a sua(u s!ranan a4u(%

*!)+!r#an +ron4oa(or 3an4a a)a pa&a p!n&!r#(a s!+a#4n'a +!r#4an

&aa) +!n(u4 4o)+#nas#, un(u4 )!n&apa(4an !$!4 'an op(#)a &!nan

!$!4 sa)p#n 'an )#n#)a%

% E4sp!4(orans &an )u4o#(#4

*!)+!r#an ;a#ran 'an ;u4up &apa( )!n!n;!r4an s!4r!(, (!(ap# pa&a

+!+!rapa 4!a&aan s!p!r(# aa 3an(un p!ru a4u4an p!)+a(asan

;a#ran%O+a( 'an )!n!4an +a(u4 s!p!r(# 4o&!#n (#&a4 an3ur4an 4ar!na

&apa( )!nanu p!)+!rs#"an s!4r!( &an )!n'!+a+4an anuan

p!r(u4aran u&ara sa)p#n #(u o+a( #n# &apa( )!n!4an pusa( napas%T!(ap#

+#a +a(u4 sana( )!nanu s!p!r(# +a(u4 'an )!n!(ap, #r#(as# sauran

napas &an anuan (#&ur o+a( #n# &apa( +!r#4an% E4sp!4(orans &an

)u4o#(#4 a#n s!p!r(# +ro)"!4s#n, &an 4ar+o4s# )!(# s#s(!#n +!r#4an pa&a

4!a&aan !4sas!r+as#% As!(# s#s(!) s!a#n +!rs#$a( )u4o#(#4 3ua )!)pun'a#

!$!4 an(# o4s#&ans 'an )!#n&un# sauran napas &an 4!rusa4an 'an

s!+a+4an o!" o4s#&ans%


33/37

:% An(#+#o(#4a

In$!4s# sana( +!rp!ran pa&a p!r3aanan p!n'a4#( paru o+s(ru4s#,

(!ru(a)a pa&a 4!a&aan !4sas!r+as#%, In$!4s# 5#rus pa#n s!r#n

)!n#)+u4an !4sas!r+as# #4u(# o!" #n$!4s# +a4(!r#% B#a #n$!4s# +!ran3u(

)a4a p!r3aanan p!n'a4#( a4an )a4#n )!)+uru4%*!nananan #n$!4s# 'an

;!pa( &an (!pa( sana( p!ru &aa) p!na(aa4sanaan p!n'a4#(% *!)+!r#an

an(#+#o(#4a &apa( )!nuran# a)a &an +!ra(n'a !4sas!r+as#%*!ru+a"an

6arna spu(u) &apa( )!rupa4an #nas# #n$!4s# +a4(!r#% An(#+#o(#4a 'an

+#asan'a +!r)an$aa( a&aa" oonan p!n#s##n, !r#(ro)#s#n &an

4o(r#)o4saso, +#asan'a +!r#4an s!a)a 7810 "ar#% Apa+#a an(#+#o(#4a

(#&a4 )!)+!r#4an p!r+a#4an )a4a p!ru a4u4an p!)!r#4saan

)#4rooran#s)!%


34/37

a4u( &an &!4o)p!nsas# 4ors p!)+!r#an Inspiratory &ositive &ressure

'reathing =I**B> +!r)an$aa( un(u4 )!n;!a" &an )!n'!)+u"4an

a(!!4(as#s%

/. Re)*b'$'t*'

R!"a+##(as# )!#pu(# (#n&a4an $#s#o(!rap#, r!"a+##(as# ps#4#s &an

p!4!r3aan%F#s#o(!rap# +!r(u3uan )!)o+##sas# &a"a4 &an )!n!n&a#4an

4ons# $#s#4 p!n&!r#(a 4! (#n4a( 'an op(#)a% B!r+aa# ;ara $#s#o(!rap#

&apa( a4u4an 'a#(u a(#"an r!a4sas#, a(#"an napas, p!r4us# nn &a&a,

&ra#nas! pos(ura &an prora) u3# a(#"% R!"a+##(as# ps#4#s +!runa un(u4

)!n!nan4an p!n&!r#(a 'an ;!)as &an )!)pun'a# rasa (!r(!4an a4#+a(

p!n'a4#(n'a%S!&an4an r!"a+##(as# p!4!r3aan a4u4an un(u4 )!)o(#5as#

p!n&!r#(a )!a4u4an p!4!r3aan 'an s!sua# &!nan 4!)a)puan $#s#4n'a%

S!;ara u)u) r!"a+##(as# #n# +!r(u3uan aar p!n&!r#(a &apa( )!nurus r#

s!nr# &an )!a4u4an a4(#5#(as 'an +!r)an$aa( s!sua# &!nan 4!)a)puan

p!n&!r#(a%

BAB I=

ANALISA KASUS

*a&a 4asus #n#, s!oran a4#-a4# +!rus#a 7< (a"un &!nan 4!u"an s!sa4

"!+a( s!3a4 1 "ar# SMRS% S!sa4 (#&a4 p!naru"# a4(#5#(as, s!sa4 s!r(a# suara

)!n#%T!r+anun )aa) "ar#4ar!na s!sa4 san4a% *as#!n )!n!u" +a(u4,

+!r&a"a4, +!r6arna pu(#" 4!4un#nan, 4ons#s(!ns#n'a 4!n(a &!nan 3u)a" 1

s&) s!(#ap 4a# +a(u4, 4!uar &ara" saa( +a(u4 san4a%D!)a) a&a, 4!r#na(pa&a )aa) "ar# (#&a4 a&a, n'!r# &a&a (#&a4 a&a, s!)+a+ pa&a 6a3a" &an 4a4#

(#&a4 a&a, )ua (#&a4 a&a,)un(a" (#&a4 a&a, na$su)a4an )!nurun (#&a4 a&a, +!ra(

+a&an (urun (#&a4 a&a%*as#!n )!a4u4an n!+u#!r ru)a" sa(u4a# )!nuna4an

o+a( 5!n(o#n na)un s!sa4 "!+a( )as#" rasa4an, au pas#!n +a6a +!ro+a(

4!IGD RSMH &an ra6a(%

S!3a4 : "ar#s!+!u) )asu4 ru)a"sa4#(, os su&a" )!n!u" s!sa4 na$as,

s!sa4 "#an (#)+u, (#&a4 p!naru"# a4(#5#(as, ;ua;a )aupun !)os#% Na$as

7


35/37

+un'# )!n# a&a, +a(u4 a&a, +!r&a"a4, 6arna pu(#", +an'a4n'a s&) (#ap

+a(u4% *as#!n )!n!u" &!)a),(#&a4 (!rau (#n#% S!r#n (!r+anun )aa) "ar#

4ar!na s!sa4 (#&a4 p!rna", n'!r# &a&a (#&a4 a&a, &a&a +!r&!+ar-&!+ar (#&a4

a&a%S!)+a+ pa&a (un4a# &an 6a3a"(#&a4 a&a, )ua (#&a4 a&a, )un(a" (#&a4

a&a,BAB &an BAK +#asa% Os )!a4u4an n!+u#!r s!nr# ru)a"n'a

)!nuna4an o+a( 5!n(o#n (#ap 4a# s!sa4% *as#!n +!u) +!ro+a( 4! ru)a" sa4#(%

Dar# ana)n!s#s, (!)u4an a&an'a s!sa4, s!r(a# +a(u4 +!ruan 'an

+!r&a"a4 "#na (!r&apa( p!ru+a"an 6arna &a"a4 &ar# pu(#" )!n3a 4!4un#nan

&an a&a r#6a'a( (!rpa3an $a4(or r!s#4o =)!ro4o4 +un4us p!r"ar# s!3a4 u)ur

0 (a"un>% D!nan p!r"#(unan In&!4s Br#n4)an 'a4n# 7?, pas#!n #n# a(a4an

s!+aa# p!ro4o4 +!ra( &an sana( +!r#s#4o )!n#&ap **OK% K!)uan pa&a

p!)!r#4saan $#s#4 (!)u4an a&an'a pursed lips breathing, barrel shaped chest,

s!r(a pa&a aus4u(as# paru (!r&apa( ron4"# &an 6"!#n !&ua apanan paru%

Dar# &a(a (!rs!+u( 4!;ur#aan a&an'a **OK &apa( (!a44an% S!(!rusn'a,

p!n!a44an anos#s pas#!n #n# &apa( pas(#4an &!nan )!nuna4an ron(!n

("oraC *A &an sp#ro)!(r#% Dar# "as# ron(!n ("oraC *A pa&a pas#!n #n# )!nun3ananos#s **OK &!nan 4!san $o(o emphisematous lung

Dar# s!uru" "as# p!)!r#4saan a(as 4a)# )!n'#)pu4an +a"6a

anos#s pas#!n #n# a&aa" **OK E4sas!r+as# &an +!4as TB%*as#!n **OK

a(a4an )!naa)# !4sas!r+as# a4u( +#a 4ons# pas#!n )!naa)# p!r+uru4an

'an +!rs#$a( a4u( &ar# 4ons# 'an s!+!u)n'a s(a+# &an &!nan 5ar#as# !3aa

"ar#an nor)a s!"#na pas#!n )!)!ru4an p!ru+a"an p!no+a(an 'an +#asa

una4an%E4sas!r+as# #n# +#asan'a s!+a+4an o!" #n$!4s# =+a4(!r# a(au 5#rus>,

+ron4ospas)!, pous# u&ara a(au o+a( oonan s!&a(#$%S!4#(ar s!p!r(#a p!n'!+a+

!4sas!r+as# #n# (#&a4 !(a"u#% *as#!n 'an )!naa)# !4sas!r+as# a4u( &apa(

(an&a# &!nan !3aa 'an 4"as s!p!r(# s!sa4 na$as 'an s!)a4#n +!r(a)+a",

+a(u4 pro&u4(#$ &!nan p!ru+a"an 5ou)! a(au puru!ns# spu(u), a(au &apa( 3ua

)!)+!r#4an !3aa 'an (#&a4 4"as s!p!r(# )aa#s!,fatigue &an anuan susa"

(#&ur% *a&a pas#!n #n# (!)u4an +a"6a )!)an (!r3a p!r+uru4an 4ons# &aa)

: "ar# (!ra4"#r SMRS &an (#&a4(!r&apa( p!r+a#4an &!nan p!no+a(an +#asa 'an

?


36/37

#a a4u4an% D#;ur#a# pa&a pas#!n #n# (!r3a #n$!4s# sauran p!rna$asan 'an

(an&a# &!nan p!ru+a"an 5ou)! &an 6arna spu(u)% S!a#n #(u, p!n#n4a(an

!u4os#( =!u4os#(#s#s> pa&a pas#!n #n# 3ua )!n#s'ara(4an s!&an (!r3a pros!s

#n$!4s#%Ma4a (!rap# $ar)a4oo#s 'an a4u4an a&aa" p!)+!r#an +ron4oa(or

&an 4or(#4os(!ro#&un(u4 )!no+a(# !4sas!r+as#n'a s!r(ap!)+!r#an an(#+#o(#4 'an

r!!5an un(u4 )!no+a(# #n$!4s# 'an (!r3a%

S!an3u(n'a 3ua p!ru4an p!)!r#4saan-p!)!r#4saan 'an )!nun3an

un(u4 p!n!a4an anos#s s!r(ap!n'#n4#ran anos#s +ann pa&a pas#!n #n#%

O!" 4ar!na #(u r!n;ana4an un(u4 a4u4an sp#ro)!(r#% *a&a 4asus #n# 3ua

r!n;ana4an a4u4an 4u(ur &an r!s#s(!ns# spu(u) s!r(a p!)!r#4saan BTA

spu(u) IIIIII%

:0


37/37

DAFTAR PUSTAKA

1% R#'an(o BS, 009% 'uu A*ar Ilmu &enyait Dalam disi #bstrusi

!aluran&ernafasan Aut Ja4ar(a2 *usa( *!n!r+#(an D!par(!)!n I*D FKUI,

00?% p%-7%

% D3o3o+ro(o, R%Dar)an(o% *!n'a4#( paru o+s(ru4(#$ 4ron#4% Daa) 2

R!sp#roo#% Ja4ar(a2 EG 00? 10-%

:% Go+a In#(#a(#5! $or "ron#; O+s(ru;(#5! Lun D#s!as! =GOLD>% 01:%

&ocet "uide to C#&D Diagnosis, -anagement, And &revention MR

.ISION,In;%

% Ja4ar(a2 D!par(!)!n K!s!"a(an RI 00 :-1%

7% S"!r6oo&, L%001% F#s#oo# Manus#a &ar# S! 4! S#s(!)% Es# %

Ja4ar(aEG%

% Yunus, Fa#sa% *!na(aa4sanaan p!n'a4#( paru o+s(ru4s#% Ja4ar(a Ba#an

pu)onoo# $a4u(as 4!&o4(!ran un#5!rs#(as #n&on!s#a 00 -:%

Case Pdl Tb Relaps Ppok Hhd

Documents

Transcript of Case Pdl Tb Relaps Ppok Hhd