Nama :
Nama : SusantiSusanti
Alamat :
Alamat : Desa MricanDesa Mrican Rt Rt 05 05 Rw Rw 0202
Sragi,
Sragi, PekaPekalonganlongan
PB
MB
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KARTU
KARTU
PENDERITA
PENDERITA
KUSTA
KUSTA
Propinsi
Propinsi : : JAWJAWA A TE!A"TE!A" #a$upaten
#a$upaten % % #ota #ota : PEMA&A!: PEMA&A! #eca'atan
#eca'atan : : ()DE"()DE"
KLA KLA SIFI SIFI KAS KAS Evalu Evalu asi asi hasil hasil peng peng obata obata n n
KETERANGAN TENTANG PENDERITA KETERANGAN TENTANG PENDERITA
N NAAMMA A : : SSuussaanntti i AALLAAMMAAT T : : DDeessaa Mrican Mrican J JEENNIIS S KKEELLAAMMIIN N : : PPeerreemmppuuaan n DDEESSA A : : MMrriiccaann ( ( Rt Rt 02/ 02/ RW RW 02 02 CARA PENEMUAN CARA PENEMUAN RIWAYAT PENYAKIT RIWAYAT PENYAKIT
KELAINAN PADA K!LIT DIKETA"!I SEJAK
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PEMERIKSAAN AWA
PEMERIKSAAN AWAL : L : Tgl 29 Juli 2016Tgl 29 Juli 2016
PEMERIKSAAN KULIT DAN SARAF PEMERIKSAAN KULIT DAN SARAF
GAMBARLA
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HASIL
HASIL PEMERIKSAAN PEMERIKSAAN BAKTERIL!IK BAKTERIL!IK ::
+ Pe'eriksaan $akteriologik an-a .ilakukan $ila SDM .an sarana terse.ia / + Pe'eriksaan $akteriologik an-a .ilakukan $ila SDM .an sarana terse.ia /
Tgl Tgl peme"i#s peme"i#s aan aan Lo#a Lo#a si : si : Hasil : Hasil : Po Po s : s : $$ $$ Agustus Agustus %&$' %&$' (upi (upi ng ng telin telin ga ga Kana Kana n n (upi (upi ng ng telin telin ga ga Ki"i Ki"i Tan) Tan) a )i a )i #ulit #ulit : :
TTulis tanggal ulis tanggal se*a"a leng#ap +se*a"a leng#ap + , tgl- bulan- tahun .
, tgl- bulan- tahun .
Penga'$ilan .i Penga'$ilan .i cuping telinga : cuping telinga : wa1i$wa1i$
Penga'$ilan
Penga'$ilan .i .i kulit kulit : : pililapilila $agian $ercak -ang paling akti $agian $ercak -ang paling akti
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PEN!B
PEN!BAATAN /AN TAN /AN E0AL1E0AL1ASI ASI HASIL HASIL PEN!BPEN!BATATAN AN ::
T
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KEA/AAN
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Cancel Anytime. Tanggal Tanggal peme"i#s peme"i#s aan : aan : Mata Mata Kan Kan an an Ki Ki "i "i A2 A2 al al &
& &&
Saa Saa t t RF RF T T
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PEMERIKSAAN
PEMERIKSAAN KNTAKNTAKK
SER1MAH SER1MAH N! N! N"#" N"#" $%&"$ $%&"$ '()u#"* '()u#"* UMUR UMUR L L$$:: PP)):: $ $ 2 2 & & 1 1 Men+i Men+i Wi+3+3 Wi+3+3 Saputra Saputra Rasm3na4 Rasm3na4 A-i A-i Darma5an Darma5an Tar3n3 Tar3n3 &2 &2 6 6 &2 &2 &0 &0 2 2
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DA!TAR TI"IK PENYU"U#AN DA!TAR TI"IK PENYU"U#AN
H
Halal--hhal al yayanng g hhararuus s ddiikketetahahuui i ppenenddereriitta.a.
Apa itu pen-akit kustaApa itu pen-akit kusta
ProseProses s penularann-apenularann-a
Per1alanaPer1alanan n pen-akitn-apen-akitn-a
R R
Apa itu reaksi kustaApa itu reaksi kusta
#apan $isa ter1a.i reaksi#apan $isa ter1a.i reaksi
Siapa -ang $isa 'engala'i reaksiSiapa -ang $isa 'engala'i reaksi
T TEENNTTAANNG G RREEAAKKSSI I KKUUSSTTAA e e T TEENNTTAANNG G PPEENNYYAAKKIIT T KKUUSSTTAA T TEENNTTAANNG G PPEENNGGOOBBAATTAAN N KKUUSSTTAA
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Geala selanutnya :
Geala selanutnya : !a !a Tidak Tidak
Bila ada jaw
Bila ada jawaban “YA” daaban “YA” dari 7 tanda-ri 7 tanda- tandatanda di
di atas, teliti atas, teliti dahulu, obati dahulu, obati seperluna!seperluna! Batuk
Batuk terus terus menemenerus rus 3 3 minmingguggu Dahak berdarah ?
Dahak berdarah ?
Kecurigaan lain untuk TB ? Kecurigaan lain untuk TB ? Atau trachoma ?
Atau trachoma ?
Diare berdarah / lendir ? Diare berdarah / lendir ? Bercak
Bercak kulit ykulit yang gatal ang gatal ?? Scabies ?
Scabies ?
Tan)a5tan)a )an ge4ala Tan)a5tan)a )an ge4ala
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FORM EVALUASI PENGOBATAN
FORM EVALUASI PENGOBATAN
PREDNISON
PREDNISON
I Innddiikkaassi i PPeemmbbeerriiaan n PPrreeddnniissoonn SSaarraann Kesimpulan Kesimpulan pemeriksaan: pemeriksaan: 1.1. AdaAdakah kah berbercak cak yanyang g ecaecah ! h ! n"n"d#$d#$ee yang ecah %
yang ecah % &.
&. AdAdakakah nah nyeyer' (r' (ekekan an aada )da )arara* %a* % +.
+. AaAakah kah kekkek#a(#a(an "("an "("( a( a(a# (a# ra)ra)a ra rabaaba berk# rang da
berk# rang da$a, -ak(# dar' $a, -ak(# dar' // b#$an (erakh'r%
b#$an (erakh'r% 0.
0. AaAakah kah ada ada $a$ag"g"(ha(ha$,#$,#) y) yang ang barbar## (erad' da$a, -ak(# dar' /
(erad' da$a, -ak(# dar' / b#$anb#$an (erakh'r % (erakh'r % 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak Pemberian Pemberian prednison : prednison : ( dosis ( dosis tunggal) tunggal)
-- 04 ,g )e$a,a & M'ngg#04 ,g )e$a,a & M'ngg#
-- +4 ,g )e$a,a & M'ngg#+4 ,g )e$a,a & M'ngg#
-- &4 ,g )e$a,a & M'ngg#&4 ,g )e$a,a & M'ngg#
-- 12 ,g )e$a,a & M'ngg#12 ,g )e$a,a & M'ngg#
-- 14 ,g )e$a,a & M'ngg#14 ,g )e$a,a & M'ngg#
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Tangga$ Tangga$ Ma(aMa(a
Lag"h Lag"h Tha$ Tha$ M#) M#) ' 'aannggaann KKaakkii 9ek#a(an 9ek#a(an Gangg# Gangg# an Ra)a an Ra)a Raba Raba Nyer' )ara* Nyer' )ara*9e9e 9#a 9#a (an "("( (an "("( Gang Gang g#an g#an Ra)a Ra)a Raba Raba 5('('k6 5('('k6 = =aarr' ' 22 IIbb# # aar Pr Peerrggee$$ PPeerr""nnee##)T'b. P")T'b. P")) 9a 9a 9a9a 9a9a 9' 9' 9a 9a 9' 9' 9a 9a 9' 9' 9a 9a 9' 9' 9a 9a 9' 9' 9a 9a 9' 9'
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Rea#si I :
Rea#si I :
$6
$6 Jenis reaksi k Jenis reaksi kusta :usta :
%6
%6 T Tanggal .iagnosa reaanggal .iagnosa reaksi :ksi :
6
6
76
76 (erlangsung $erapa la'a :(erlangsung $erapa la'a :
Rea#si II :
Rea#si II :
$6
$6 Jenis reaks Jenis reaksi kusta :i kusta :
66
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PEMERIKSAAN KLINIK ULANG
PEMERIKSAAN KLINIK ULANG
•
• &e'$ar ini .ise.iakan untuk 'encatat &e'$ar ini .ise.iakan untuk 'encatat peru$aan3peru$aan tan.a3tan.a -angperu$aan3peru$aan tan.a3tan.a -ang
'ungkin .i1u'pai sela'a pengo$atan, saat R7T setela R7T, atau tentang pengo$atan
'ungkin .i1u'pai sela'a pengo$atan, saat R7T setela R7T, atau tentang pengo$atan
% asil pengo$atan -ang .i$erikan6
% asil pengo$atan -ang .i$erikan6
•
• 4atatla al3al -ang penting64atatla al3al -ang penting6 •
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Cancel Anytime. % % KARTU ,ER,AT MDT KARTU ,ER,AT MDT -Nama : Nama : 7777777777777777777777777777778888 Ke-amin / !
Ke-amin / !mur : mur : L, :7778Pr: 777L, :7778Pr: 7777777
Pe,er9aan : 77777777777777 Pe,er9aan : 77777777777777 A-amat A-amat : 7777877777777777: 7777877777777777 1ntu# 1ntu# pengambilan pengambilan obat )ilua" obat )ilua" pus#esmas pus#esmas asal6 asal6
Ti.ak perlu .iisi Ti.ak perlu .iisi
$ila $ila o$at .ia'$il .i o$at .ia'$il .i puskes'as asal6 puskes'as asal6 Bliste" Bliste" #e #e /ibe"i#a /ibe"i#a n )i n )i pus#es pus#es mas: mas:
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JADW
JADW
A& M
A& MA
A
T
T
A PE&
A PE&
AJAR
AJAR
A
A
#E&AS =A SMP 9
#E&AS =A SMP 9
PETAR>#A
PETAR>#A
S
S
E
E
N
N
I
I
N
N
S
S
E
E
L
L
A
A
S
S
A
A
R
R
A
A
B
B
U
U
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