PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN PRIMER PDF

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PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN PRIMER EDISI I 1/1/2013 1 CATATAN PENTING 1. Panduan Praktik Klinis (PPK) Dokter Pelayanan Primer ini memuat penatalaksanaan untuk dilaksanakan oleh seluruh dokter pelayanan primer serta pemberian pelayanan kesehatan dengan upaya te...

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PANDUAN PRAKTIK KLINIS BAGI DOKTER DI FASILITAS PELAYANAN KESEHATAN PRIMER

EDISI I 1/1/2013

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CATATAN PENTING

1. Panduan Praktik Klinis (PPK) Dokter Pelayanan Primer ini memuat penatalaksanaan untuk dilaksanakan oleh seluruh dokter pelayanan primer serta pemberian pelayanan kesehatan dengan upaya terbaik di fasilitas pelayanan kesehatan primer tetapi tidak menjamin keberhasilan upaya atau kesembuhan pasien. 2. Panduan ini disusun berdasarkan data klinis untuk kasus individu berdasarkan referensi terbaru yang ditemukan tim penyusun, dan dapat berubah seiring kemajuan pengetahuan ilmiah. 3. Kepatuhan terhadap panduan ini tidak menjamin kesembuhan dalam setiap kasus. Setiap dokter bertanggung jawab terhadap pengelolaan pasiennya, berdasarkan data klinis pasien, pilihan diagnostik, dan pengobatan yang tersedia. 4. Modifikasi terhadap panduan ini hanya dapat dilakukan oleh dokter atas dasar keadaan yang memaksa untuk kepentingan pasien, antara lain keadaaan khusus pasien, kedaruratan, dan keterbatasan sumber daya. Modifikasi tersebut harus tercantum dalam rekam medis. 5. Dokter pelayanan primer wajib merujuk pasien ke fasilitas pelayanan lain yang memiliki sarana prasarana yang dibutuhkan bila sarana prasarana yang dibutuhkan tidak tersedia, meskipun penyakit yang ditangani masuk dalam kategori penyakit tingkat kemampuan 4. 6. PPKDokter Pelayanan Primer tidak memuat seluruh teori tentang penyakit, sehingga sangat disarankan setiap dokter untuk mempelajari penyakit tersebut dengan menggunakan referensi yang dapat dipertanggungjawabkan. 7. Walaupun tidak menjadi standar pelayanan, skrining terhadap risiko penyakit merupakan tugas dokter pelayanan primer.

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TIM PENYUSUN

Pengarah Menteri Kesehatan Republik Indonesia Direktur Jenderal Bina Upaya Kesehatan Ketua Umum Pengurus Besar Ikatan Dokter Indonesia Direktur Jenderal Bina Upaya Kesehatan Dasar Tim Editor dr. Daeng M Faqih,M.H dr. Mahesa Paranadipa,M.H dr. Dhanasari Vidiawati Trisna,M.Sc,CM-FM dr. Dyah A Waluyo Dr.dr.Herqutanto,MPH,MARS dr.Fika Ekayanti,M.Med.Ed dr.Joko Hendarto,DAP&E dr.Andi Alfian Zainuddin,MKM dr.Ika Hariyani Kelompok Kerja dr. Daeng M Faqih,MH dr. Mahesa Paranadipa,MH dr. Slamet Budiarto,SH,MH.Kes drg. Bulan Rachmadi,M.Kes dr. Dyah A Waluyo Dr.dr. Siti Pariani,MS,MSc,Ph.D Dr.dr. Darwis Hartono,MHA,PKK dr. Abraham Andi Padlan Patarai,M.Kes dr. Imelda Datau dr. Andi Alfian Zainuddin,MKM dr. Judilherry Justam, MM, ME dr. Dhanasari Vidiawati Trisna,MSc,CM-FM dr. Susi Oktowati dr. Wahyudi Istiono,M.Kes dr. R. Prihandjojo Andri Putranto,MSi dr. Exsenveny Lalopua,M.Kes dr. Monika Saraswati Sitepu, MSc (Trop.Med) dr. Novana Perdana Putri

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Narasumber Prof.Dr.Wiwien Heru Wiyono,Ph.D, Sp.P(K) – Kolegium Pulmonologi dan Ilmu Kedokteran Respirasi dr.Nurdadi Saleh,Sp.OG – PB POGI dr. SH Manullang, Sp.B – PP PABI dr. Muzal Kadim, Sp.A – PP IDAI dr.Syahrial M Hutauruk,Sp.THT-KL – PP PERHATI-KL dr.Eka Ginanjar,Sp.PD,FINASIM – PB PAPDI dr.Prasetyo Widhi B, Sp.PD, FINASIm – PB PAPDI Dr.dr.Tjut Nurul Alam Jacoeb,Sp.KK(K) – PP PERDOSKI dr.Hanny Nilasari,Sp.KK – PP PERDOSKI dr.Diatri Nari Lastri,Sp.S(K) – PP PERDOSSI dr.M. Sidik,Sp.M(K) – PP PERDAMI dr.Gerald Mario Semen,Sp.KJ – Direktorat Bina Kesehatan Jiwa, Kemenkes RI dr. Natalingrum S, SpKJ, M.Kes - Direktorat Bina Kesehatan Jiwa, Kemenkes RI dr.Lily Banonah Rivai,M.Epid – Subdit Pengendalian PJPD, Dit PPTM, Kemenkes RI dr.Sylviana Andinisari,M.Sc –Subdit Pengendalian DM & PM, Kemenkes RI dr.Arie Hamzah – Subdit Pengendalian DM & PM, Kemenkes RI dr.Worowijat,MKM – Subdit Pengendalian Malaria Ditjen P2PL, Kemenkes RI dr.Eka Sulistiany – Subdit Tuberkulosis Ditjen P2PL, Kemenkes RI dr.Hariadi Wisnu Wardana – Subdit AIDS & PMS, Kemenkes RI dr.Yoan Hotnida Naomi,MSc – Subdit Pengendalian Penyakit Jantung dan Pembuluh Darah, Kemenkes RI dr. Hadiyah Melanie – Direktorat Bina Kesehatan Ibu, Kemenkes RI dr. Hj. Eni Gustina, MPH – Direktorat Bina Kesehatan Anak,Kemenkes RI Tim Kontributor Dr.dr. Darwis Hartono,MHA,PKK dr. Dhanasari Vidiawati Trisna,MSc,CM-FM dr. Susi Oktowati dr. Wahyudi Istiono,M.Kes dr. Exsenveny Lalopua,M.Kes dr. Retno Asti Werdhani,M.Epid dr. Duta Liana, MARS dr. Balqis,M.Sc,CM-FM dr.Fika Ekayanti,M.Med.Ed dr.Joko Hendarto,DAP&E dr. Andi Alfian Zainuddn,MKM dr. Ulul Albab dr. Trisna dr. Ira Susanti Haryoso dr. Alfii Nur Harahap dr. Alfuu Nur Harahap 4

Tim Penunjang dr. Adi Pamungkas drg. Leslie Nur Rahmani Dra.Dien Kuswardani Esty Wahyuningsih,S.Kep,Ns I.G.A.M Bramantha Yogeswara,S.T,M.Si Putri Haris,SKM Heti Yuriani,S.Pd Mohammad Sulaeman,S.H Husin Maulachelah

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DAFTAR ISI

SEJARAH PENYUSUNAN ........................................................................................................15 SAMBUTAN .................................................................................................................................17 PENGANTAR ..............................................................................................................................19 BAB I .............................................................................................................................................21 BAB II ...........................................................................................................................................25 BAB III ..........................................................................................................................................28 III. 1. KELOMPOK UMUM ..................................................................................................... 28 1. Tuberkulosis (TB) Paru ....................................................................................................28 2. Morbili .............................................................................................................................36 3. Varisela ............................................................................................................................39 4. Malaria .............................................................................................................................41 5. Demam Dengue dan Demam Berdarah Dengue ..............................................................45 6. Leptospirosis ....................................................................................................................49 7. Infeksi Pada Umbilikus ....................................................................................................52 8. Kandidiasis Mulut ............................................................................................................54 9. Lepra ................................................................................................................................56 10. Keracunan Makanan.......................................................................................................64 11. Alergi Makanan ..............................................................................................................66 12. Exanthematous Drug Eruption .......................................................................................68 13. Fixed Drug Eruption (FDE) ...........................................................................................71 14. Reaksi Anafilaktik..........................................................................................................74 15. Syok ................................................................................................................................80 III.2. DARAH, PEMBENTUKAN DARAH, SISTEM IMUN ................................................ 86 16. Anemia ...........................................................................................................................86 17. HIV/AIDS tanpa Komplikasi .........................................................................................90 18. Limfadenitis .................................................................................................................102 III.3. DIGESTIVE ................................................................................................................... 106 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.

Refluks Gastroesofageal ...............................................................................................106 Gastritis ........................................................................................................................109 Intoleransi Makanan .....................................................................................................111 Malabsorbsi Makanan ..................................................................................................113 Demam Tifoid ..............................................................................................................116 Gastroenteritis (termasuk disentri, kolera dan giardiasis) ............................................121 Disentri Basiler dan Disentri Amuba ...........................................................................126 Apendisitis Akut ...........................................................................................................129 Perdarahan Saluran Makan Bagian Atas ......................................................................133 Perdarahan Saluran Makan Bagian Bawah ..................................................................139 6

29. Hemoroid Grade 1-2 ....................................................................................................144 30. Hepatitis A ...................................................................................................................147 31. Hepatitis B ....................................................................................................................150 32. Parotitis ........................................................................................................................153 33. Askariasis .....................................................................................................................155 34. Cutaneus Larva Migrans..............................................................................................158 35. Penyakit Cacing Tambang ..........................................................................................160 36. Skistosomiasis ..............................................................................................................163 37. Strongiloidiasis .............................................................................................................166 38. Taeniasis .......................................................................................................................168 39. Peritonitis .....................................................................................................................170 40. Kolesistitis ....................................................................................................................173 III.4. MATA ............................................................................................................................ 176 41. Mata Kering/Dry eye ....................................................................................................176 42. Buta Senja ....................................................................................................................178 43. Hordeolum....................................................................................................................179 44. Konjungtivitis ...............................................................................................................181 45. Blefaritis .......................................................................................................................184 46. Perdarahan Subkonjungtiva .........................................................................................186 47. Benda asing di konjungtiva ..........................................................................................188 48. Astigmatism .................................................................................................................190 49. Hipermetropia ..............................................................................................................192 50. Miopia Ringan ..............................................................................................................195 51. Presbiopia .....................................................................................................................196 52. Katarak pada Pasien Dewasa .......................................................................................198 53. Glaukoma Akut ............................................................................................................200 III.5. TELINGA....................................................................................................................... 205 54. Otitis Eksterna ..............................................................................................................205 55. Otitis Media Akut .........................................................................................................208 56. Serumen Prop ...............................................................................................................213 III.6. HIDUNG ........................................................................................................................ 216 57. Benda Asing di Hidung ................................................................................................216 III.7. KARDIOVASKULAR................................................................................................... 219 58. Angina Pektoris ............................................................................................................219 59. Infark Miokard .............................................................................................................224 60. Takikardia ....................................................................................................................228 61. Gagal Jantung Akut dan Kronik ...................................................................................230 62. Cardiorespiratory Arrest .............................................................................................234 63. Hipertensi Esensial .......................................................................................................236 64. Infark Serebral/Stroke ..................................................................................................243 III.8. MUSKULOSKELETAL ................................................................................................ 248 7

65. Fraktur Terbuka ............................................................................................................248 66. Fraktur Tertutup ...........................................................................................................251 67. Polimialgia Reumatik ...................................................................................................253 68. Artritis Reumatoid........................................................................................................256 69. Artritis, Osteoartritis ....................................................................................................261 70. Lipoma .........................................................................................................................263 III.9. NEUROLOGI................................................................................................................. 266 71. Kejang Demam.............................................................................................................266 72. Vertigo..........................................................................................................................269 73. Delirium .......................................................................................................................276 74. Tetanus .........................................................................................................................279 75. Rabies ...........................................................................................................................285 76. Epilepsi.........................................................................................................................289 77. Status Epileptikus .........................................................................................................297 78. Migren ..........................................................................................................................300 79. Bells’ Palsy...................................................................................................................305 80. Tension Headache ........................................................................................................311 III.10. PSIKOLOGIS............................................................................................................... 315 81. Insomnia .......................................................................................................................315 82. Demensia ......................................................................................................................317 83. Gangguan Campuran Anxietas dan Depresi ................................................................320 84. Gangguan Psikotik .......................................................................................................323 III.11. RESPIRASI .................................................................................................................. 328 85. Epistaksis......................................................................................................................328 86. Furunkel Pada Hidung..................................................................................................333 87. Faringitis ......................................................................................................................335 88. Rhinitis Akut ................................................................................................................340 89. Rhinitis Alergik ............................................................................................................344 90. Rhinitis Vasomotor ......................................................................................................349 91. Tonsilitis .......................................................................................................................352 92. Laringitis ......................................................................................................................358 93. Bronkitis Akut ..............................................................................................................362 94. Influenza .......................................................................................................................367 95. Pneumonia Aspirasi .....................................................................................................369 96. Pneumonia dan Bronkopneumonia ..............................................................................371 97. Pertusis .........................................................................................................................375 98. Asma Bronkial ...............................................................................................................