Sign that frequently seen in kidney diseases including anemia, hypertension, and edema. If a patient come to seek the treatment with nausea, vomiting, fatigue, hypertension
and edema always think that the most possibility is chronic kidney diseases. Renal colic is a severe pain at right or left lumbal region and referred to genital region. Also accompanied by
percussion pain at costovertebral angle.
Test for kidney patient include routine laboratory test, imaging, and biopsy. Laboratory test, including, routine hematology, urinalysis, ureumBUN, creatinine, electrolyte K,Na, uric
acid serum, urine volume, in special scenario, blood gas analysis, total protein and albumin, calsium, anorganik phosphate maybe required. Another examination should be done based
on their indication. Clearence creatinine test is important in measuring glomerular filtration rate.Imaging examination including BNO, IVP, Ultrasonography, CT Scan and, retrograde
pielography. Urine cytology and renal biopsy can be done based on indication.
One of the necessary laboratory examination is the examination of the microbiology laboratory. To be able to produce accurate data from the microbiological examination, the
specimen quality is a factor that must be considered. A good quality specimen is needed to assist in establishing a reliable diagnosis. Improper management of specimens, both in terms
of collection, storage, or transportation, can lead to failure in finding the cause of microorganisms. Interpretation of result culture and susceptibility testing must be tailored
according to the patient at risk and the specimen type submitted. There are three things that should be considered in cases of urinary tract infections are the colony count of
microorganisms growing in culture, measurement of pyuria and presence or absence of symptoms dysuria and frequency. Knowledge of the normal flora in the area genetalia are
also required similarly with microorganisms that are often the causes of urinary tract infections are very helpful in determining the culture of an agent causing the infection or
merely contamination only.
Anamnesis and Physical Examination in Urinary System and Male Genital System Disorders
Learning task
Title :
Anamnesis and physical examination in lower urinary tract disorders Objective
: Student can do structured anamnesis and physical examination in
lower urinary tract disorders Competency
bold letter :
1. Anamnesis skill
2. Physical examination skill
3. Skill in clinical procedure or interprate data from laboratory
finding andor imaging to making a diagnosis or diferensial diagnosis
4. Management
5. Patient education and communication
6. Profesional behaviour
Instruction for the studen
: Clinical scenario 1:
A-25-year old man come to the primary health care service with pain during urination.
Clinical Scenario 2: A-40-year old man come to the primary health care service with
fever and flank pain.
Clinical scenario 3: Two years old boy came with complaint of left scrotal enlargement
since he was born
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For each clinical scenario: Do the role play, one student as a doctor and one student as a
patient Task:
1.
Do the anamnesis and physical examination 2.
Mention your diagnosis dan minimum 1 diferensial diagnosis
Check List
Skills 1
2 3
Bob ot
Sk or
Anamnesi s
Mahasiswa tidak melakukan
anamnesis Mahasiswa
melakukan anamnesis, hanya
menanyakan tentang keluhan
utama saja Mahasiswa
melakukan anamnesis,
menanyakan Basic 7 dan fundamental
4 tapi tidak lengkap.
Mahasiswa melakukan
anamnesis, menanyakan
Keluhan utama, basic 7 dan
fundamental 4 dengan lengkap.
3
Pemeriks aan fisik,
meliputi Vital sign
dan status
lokalis Mahasiswa tidak
melakukan pemeriksaan fisik
Mahasiswa melakukan
pemeriksaan fisik, tapi sebelum dan
setelah kontak dengan pasien
tidak cuci tangan Mahasiswa
melakukan cuci tangan sebelum
dan setelah kontak dengan pasien dan
mahasiswa melakukan dengan
tidak lengkap atau tidak benar
pemeriksaan fisik berikut:
1.
Vital sign
2.
Pemeriks aan
status lokalis:
Palpasi bladder
Mahasiswa melakukan cuci
tangan sebelum dan setelah kontak
dengan pasien dan mahasiswa
melakukan dengan lengkap dan benar
pemeriksaan fisik berikut:
1.
Vital sign Pemeriks
aan status
lokalis: Palpasi
bladder 3
Menentuk an
diagnosis Mahasiswa tidak
bisa membuat diagnosis
Mahasiswa membuat
diagnosis namun tidak lengkap
Mahasiswa membuat
diagnosis dengan benar namun tidak
bisa membuat diferensial
diagnosis Mahasiswa
membuat diagnosis dengan
benar dan bisa membuat minimal
satu diferensial diagnosis yang
benar 2
Komunika si edukasi
pasien dan
Mahasiswa tidak melakukan semua
hal berikut: Mahasiswa hanya
melakukan 1 dari hal berikut:
Mahasiswa melakukan 2-3 dari
hal berikut: Mahasiswa
melakukan semua hal berikut:
1
Udayana University Faculty of Medicine, DME 40 |
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perilaku profesion
al
1.
menguca pkan
salam, perkenala
n
2.
Melakuka n kontak
mata dengan
pasien dan
berempati
3.
menjelas akan dan
meminta ijin untuk
melakuka n perasat,
4.
memperh atikan
kenyama nan
pasien
1.
menguca pkan
salam, perkenala
n
2.
Melakuka n kontak
mata dengan
pasien dan
berempati
3.
menjelas akan dan
meminta ijin untuk
melakuka n perasat,
4.
memperh atikan
kenyama nan
pasien
1.
menguca pkan
salam, perkenala
n
2.
Melakuka n kontak
mata dengan
pasien dan
berempati
3.
menjelas akan dan
meminta ijin untuk
melakuka n perasat,
4.
memperh atikan
kenyama nan
pasien
1.
menguca pkan
salam, perkenala
n
2.
Melakuka n kontak
mata dengan
pasien dan
berempati
3.
menjelas akan dan
meminta ijin untuk
melakuka n perasat,
4.
memperh atikan
kenyama nan
pasien
Total
Global Rating Score lingkari: tidak lulus, borderline, lulus, superior
Urethral Catheterization
Learning task
Title :
Urethral Catheterization
Objective :
Student is competent to perform Urethral Catheterization on maniquine.
Competency bold letter
: 1.
Anamnesis skill 2.
Physical examination skill 3.
Skill in clinical procedure or interpret data from laboratory finding andor imaging to making a diagnosis or differential
diagnosis 4.
Management 5.
Patient education and communication 6.
Profesional behaviour Instruction for the
students :
Clinical Scenario: A 60 years old male patient, come to Primary Health Care Center
with unable to urinate.
Instruction:
Perform Urethral Catheterization on this patient.
Instruction for the facilitators
: 1.
Facilitator will allow student to perform urinary catheterization on mannequin in sequence.
2. Facilitator must observe and evaluate each of student
performance with checklist provided below.
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3. Facilitator must give feedback to each student based on their
individual performance and also encourage each student to give feedback to their own performance.
CATHETERIZATION CHECK LIST Male
No Skills
Score 1
2
1 Introduce your self, explain what you would like to do
and obtain concent 2
Hand washing before and afterprocedure 3
Lie the patient comfortably with his legs slightly separated
4 Choose a catheter, open the catheterization pack,
pour antiseptic into the reciever and put on gloves 5
Clean the penis throughly, retract the prepuce and clean around the meatus
6 Drape, so that only penis is in sterile field
7 Hold the penis with a gauze swab; squeeze
anaestheticlubricant jelly into the urethra and occlude it with pressure from the gauze
8 Advance the catheter tip from its sleeve and introduce
to urethra, Advance the catheter using a “no touch technique”, or with sterile forceps, until the end arm of
the catheter is up to the meatus 9
Inflate the baloon: inject about 5ml of water and check that it does not cause pain before fully inlating it
10 Attach the bag, gently extend the catheter into
position, reposition the prepuce 11
Record the volume of urine in the bag residual volume
Total Score Total Score
Final score = --------------- x 100 =
22 Female
No Skills
Score 1
2
1 Introduce your self, explain what you would like to do
and obtain concent 2
Hand washing before and after procedure
Udayana University Faculty of Medicine, DME 42 |
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3 Lie the patient comfortably with his legs slightly
separated 4
Choose a catheter, open the catheterization pack, pour antiseptic into the reciever and put on gloves
5 Clean the vulva
6 Drape, so that only vulva is in sterile field
7 Advance the catheter tip from its sleeve and introduce
to urethra, Advance the catheter using a “no touch technique”, or with sterile forceps
8 Inflate the baloon: inject about 5ml of water and check
that it does not cause pain before fully inlating it 9
Attach the bag, gently extend the catheter into position, reposition the prepuce
10 Record the volume of urine in the bag residual
volume Total Score
Total Score Final score = --------------- x 100 =
20
Urinalysis Learning Task 1
1. There are 3 urinalysis results provided. Analyze and conclude each of it?
2. Explain correctly and completely the technique of urine collection?
Imaging in Urinary System Disorders
Learning task 1
Title :
Anamnesis , physical examination and interpret data from abdominal X-ray BOFBNO in urinary system disorders.
Objective :
Student can do structured anamnesis, physical examination and make a right interpretation from BOFBNO in urinary tract disorders
Competency bold letter
: 1.
Anamnesis skill 2.
Physical examination skill 3.
Skill in clinical procedure or interprate data from laboratory finding andor imaging to make a diagnosis or
diferensial diagnosis
4. Making diagnosis and diferential diagnosis
