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Consulent:
Dr M. Isa, Sp.P (K)
Patient Data
Name : Mr. L
Sex : Male
Age : 70 y.o.
Race : Banjar
Address : Kelayan, Banjarmasin
ALLOANAMNESIS
Chief Complaint : Bleeding cough
Patient complained of cough since 3 weeks ago. The cough consist
of slime, white and yellowish, mixed with clots of dark blood.
Bleeding cough appeared since a week ago. In a day, slime about 2
glass of mineral water. Patient also complained about loss of
weight, loss of appetite. Patient looks weak and listless. Patient
always felt cold sweat every evening in the last 3 weeks.
1 weeks ago
Hemaptoe since Tuberculosis Bronkiektasis Kultur
Sputum Trendelenburg
position
TTV
Bleeding
loss of weight sign
High calori
loss of appetite High protein
Diet
felt cold sweat
Pharmacology
NaCl 20 tpm
Po. Codein 3x1
Pro OAT`
Cue and Clue Problem List Idx PDx PTx Pmo
NaCl 20 tpm
Inj. Tranexamat
acid 3x1 amp
Inj. Omeprazole
2x1 amp
Inj. Ranitidin
2x1 amp