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• Assessment
• This section documents the synthesis of
“subjective” and “objective” evidence to arrive
at a diagnosis. This is the assessment of the
patient’s status through analysis of the
problem, possible interaction of the problems,
and changes in the status of the problems.
Elements include the following.
• Problem
• List the problem list in order of importance. A
problem is often known as a diagnosis.
• Differential Diagnosis
• This is a list of the different possible diagnosis,
from most to least likely, and the thought
process behind this list. This is where the
decision-making process is explained in depth.
Included should be the possibility of other
diagnoses that may harm the patient, but are
less likely.
• Example: Problem 1, Differential Diagnoses,
Discussion, Plan for problem 1 (described in the
plan below). Repeat for additional problems
• Plan
• This section details the need for additional
testing and consultation with other clinicians to
address the patient's illnesses. It also addresses
any additional steps being taken to treat the
patient. This section helps future physicians
understand what needs to be done next. For
each problem:
• State which testing is needed and the rationale
for choosing each test to resolve diagnostic
ambiguities; ideally what the next step would
be if positive or negative
• Therapy needed (medications)
• Specialist referral(s) or consults
• Patient education, counseling
• Penyempitan arteri koroner nonsklerolik
• Penyempitan aterorosklerotik
• Trombus
• Plak aterosklerotik
• Lambatnya aliran darah didaerah plak atau oleh
viserasi plak
• Peningkatan kebutuhan oksigen miokardium
• Penurunan darah koroner melalui yang menyempit
• Penyempitan arteri oleh perlambatan jantung
selama tidur
• Spasme otot segmental pada arteri kejang otot.
• Clopidogrel has been used as
secondary prevention of
atherosclerotic events in patients
with a history of stroke, MI, or
peripheral vascular disease and
those at high risk of vascular events
who have major contraindications
to aspirin.
• Side effect : Dermatologic: Rash
(4%), pruritus (3%) Hematologic:
Bleeding (major 4%; minor 5%),
purpura/bruising (5%), epistaxis
(3%
• Aspirin has an established role in
preventing thrombotic events in
cardiovascular disease. Patients
with a history of MI, stroke,
prosthetic valve (nonmechanical),
CAD, atrial fibrillation (AF),
coronary-artery stenting, coronary
artery bypass grafting (CABG), or
peripheral artery disease should
be on a daily dose of 81 or 325
mg of aspirin (enteric-coated
preferred).
• Side effect : Anemia, bleeeding,
coagulopathy, disseminated
intravascular coagulation
 DM

Non-
DM
• Komposisi makanan yang dianjurkan
• Karbohidrat  45-65% total asupan energi, dianjurkan untuk makan 3 kali
sehari
• Lemak  20-25% total asupan energi, konsumsi kolesterol <200mg/hari,
hindari makanan yang mengandung lemak jenuh atau trans e.g daging
berlemak, susu fullcream
• Protein  10-20% total asupan energi, sumber protein yang baik adalah
ikan, udang, cumi, daging tanpa lemak, ayam tanpa kulit, produk susu rendah
lemak, kacang-kacangan, tahu dan tempe.
• Serat  20-35 g/hari dari kacang-kacangan, buah, sayuran, serta sumber
karbohidrat berserat tinggi

• Kegiatan jasmani sehari-hari dan latihan teratur (3-5 kali seminggu

selama kurang lebih 30-60 menit minimal 150 menit/minggu
intensitas sedang). Kegiatan sehari-hari seperti berjalan kaki ke
pasar, enggunakan angga, berkebun, harus tetap dilakukan
Jenis2
OHO
• HbA1C >9% dengan kondisi dekompensasi metabolik
• Penurunan berat badan yang cepat
• Hiperglikemia berat yang disertai KAD
• Krisis hiperglikemia
• Gagal dengan kombinasi OHO dosis maksimal
• Stres berat i.e. Infeksi sistemik, operasi besar, AMI, stroke
• Kehamilan dengan DM
• Gangguan fungsi ginjal dan hati
• Kontraindikasi atau alergi terhadap OHO
• Kondisi perioperatif
• Pemeriksaan kadar gula darah i.e. GDP, GD2PP, GDS berkala
sesuai dengan kebutuhan
• HbA1C  setiap 3 bulan
• PGDM  dianjurkan pada pasien yang menggunakan insulin
lebih dari satu kali perhari. Waktu yang dianjurkan adalah 2
jam setelah makan, menjelang waktu tidur, diantara siklus tidur,
atau saat sedang mengalami gejala seperti hypoglicemia spell
 PERSIAPAN

Dihangatk Dikocok
an dengan
dengan 10 kali
10 kali gerakan
gerakan
• Efek samping utama adalah hipoglikemia
• Efek samping lainnya berupa alergi
• Konsensus DM PERKENI 2015
• Konsensus Nasional GERD 2013
• PPK dokter di Fasyankes primer
• Bate’s Guide to Physical Examination and History Taking