Don’t Touch me

Mr.Adi, a 36 years old, came to the doctor with chief complain of coughing up
blood since 3 days ago. Mr.Adi often cough with greenish white mucous since one
month ago, followed by mild fever, profuse nocturnal sweating, decreased of apetite,
weight loss, and sometimes cough accompanied by chest pain. Mr.Adi lived at the
slum with his wife and 3 years old son. His co-worker also suffer the same complain.
Mr.Adi never experience this symptom before. Doctor recommend Mr. Adi to get
lung x-ray examination.

Physical examination.

Sense : compos menti, BW 60 kg, Height 164 cm.

Vital sign : BP 110/70 mmHg, Pulse 98x/minute, RR 20x/minute, T 37.7̊C

Specific examination:

Head : anemic conjungtive (-)

Thoraks : pulmo

Inspection : lung movement static and dynamic symmetric

Palpation : increased of steam fremitus on the right upper lobe

of the lung.

Percution : dullness on the right apex of the lung

Auscultation : increase of vesicular and moderate rales

2.3 Terms of Clarification

1. Mucous : is a normal, slippery and stringly fluid substance produce by many
lining tissue in the body
2. Coughing : is a common reflex action that clears the throats of mucous or
foregin iritans
3. ESR : eritrosit sedimentation rate, the rate at which red blood cell sediment
in a period of one hour.
4. Lung X-Ray examination : the chest x-ray the most commonly performed
diagnostic x-ray examination can produceimage of the lungs airways, bood
vessel and the bones of the spine
5. Stem fremitus : a decresed suggest air or fluid in the pleura spaces or
decreased in lung issue density
 6. Profuse nocturnal sweating : the occurrence of excessive sweating during
sleep. The person may or may not alsoperspire excessively while awake
7. Lived the slum : high life populate urban people in area obesity where living
condition are very bad and where the houses are in bad condition
8. Hemoptysis : the sptting of blood or originated in the lung or bronchial tubes

2.4 Identification of Problem

1. Mr. Adi, a 36 years old ……. By chest pain
2. Mr. Adi lived …… x-ray exam
3. Physical exam & specific exam
4. Additional exam

Priority Issue
No.1

Analysis of Problem

a. How is the anatomy and physiology in this case? (danu, sani, desty)
b. What is the etiology of coughing of blood? (nanda, nunung, muti)
c. What is the meaning of coughing blood since 3 days ago? (hakim, apil, ecak)
d. What are the types of cough? (kak sheilla, danu, sani)
e. What is the pathophysiology of coughing of blood? (desty, nanda, nunung)
f. What is etiology of cough with greenish white mucous? (muti, hakim, apil)
g. What are the types of mucous? (ecak, kak sheilla, danu)
h. What is etiology of followed by mild fever, profuse nocturnal sweating,
decreased of apetite, weght loss, and sometimes cough accompanied by
chest pain? (sani, desty, nanda)
i. What is the meaning of cough with greenish white mucous since one month
ago, followed by mild fever, profuse nocturnal sweating, decreased of
apetite, weight loss, and sometimes cough accompanied by chest pain?
(nunung, muti, hakim)
j. What is the pathophysiology of cough with greenish white mucous since one
month ago, followed by mild fever, profuse nocturnal sweating, decreased of
apetite, weight loss, and sometimes cough accompanied by chest pain? (apil,
ecak, kak sheilla)
k. What is the relation of gender, age with his complain? (danu, nanda, hakim)
l. What is the relation of the complaint with chief complain? (sani, nunung,
apil)
2.

a. What is the meaning lived at the slum with his wife & 3 years old son?
(desty, muti, ecak)
b. What is the meaning his co – worker also suffer the same complains? (kak
sheilla, danu, nanda)
c. What is the meaning never experience this symptoms before? (hakim, sani,
nunung)
d. What is the meaning the doctor recommend mr. ardi to get lung x-ray? (apil,
desty, muti)
e. What is the imunopathogenesis in this case? (ecak, kak sheilla, danu)
f. How is the trasmission and the prevention of this desease? (nanda, hakim,
sani)
g. How to do examinations of a lung x-ray? (nunung, apil, desty)

3.

a. What is the interpretation of Physical and Specific examination? (muti, ecak,

kak sheilla)
b. How is the mechanism of abnormal Physical and Specific examination?
(nunung, sani, apil)

4.

a. What is the interpretation of Additional examination? (hakim, desty, danu)

b. How is the mechanism of abnormal Additional examination? (nanda, ecak,
muti)

5. How to diagnose ? (kak sheilla)

6. What is the differential dignose ? (danu, sani)
7. What is supporting examination ? (desty, nanda)
8. What is working diagnose ?
9. How to governance? (nunung, muti, ecak)
10. What is complication ? (apil, hakim)
11. What is prognose ?
12. What is KDU ?
13. What is NNI ? (kak sheilla, nanda, hakim)
Conclusion
Mr.Adi, a 36 years old, came with complain of coughing up blood, cough with
greenish white mucous, mild fever, profuse nocturnal sweating, decreased of
apetite, weight loss, and chest pain because of lung TB.

Conceptual Framework
Risk factor (transmission and environtmet), age, gender > droplet of the
mycobacterium tuberculosis > replicate in the body human (lung)> imun system
decreased > lung tuberculosis > coughing up blood, cough with greenish white
mucous, mild fever, profuse nocturnal sweating, decreased of apetite, weight
loss, and chest pain because of lung TB