Travelling HD Versi PHC Indonesia Inggris [PDF]

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Nama



: Kala Subheida, Mrs



Name



TRAVELLING DIALYSIS



Umur : CKD STG V on Reguler Haemodialysis



Diagnosa Utama



: 48 years



Age



Primary Diagnosis



Diagnosa Sekunder



Jenis Kelamin



:



( P H C Hospital S u r a b a y a ) Secondary Diagnosis Jl. Prapat kurung Selatan No.1 Surabaya – Indonesia. Riwayat Penyakit : Hypertension Phone +62 31 3294801, Fax. +62 31 3294804 History



: Male



Sex



: 385704



Nomer Register Reg. Number



Date of Beginning Dialysis : 30 November 2010



Alamat : Sukun 13/2 Kamal Tanggal Terakhir HD Address Madura Date of Last Dialysis : 10 Desember 2012



PRESENT TREATMENT Tekanan Darah



Frekwensi HD



Tanggal Awal HD



Blood Pressure



Sistole : 150 - 180 Diastole : 90 - 120



: Five days



Dialysis Frequency



Optimal Blood Flow



: 200 Rpm



Mean/ Optimal blood flow



Tempat dilakukan HD



: Hospital



Place of Dialysis



: 4 - 5 hours



Lamanya HD Duration per Dialysis



Komposisi Dialisat



: Bicarbonat



Composition of Dialysate



: Negative



Sero Marker Hepatitis Hepatitis sero marker



Tipe Dializer



: F8 HPS Fresenius



Type of used Dialyzer



Riwayat Transfusi Darah



: None



History of Blood Transfusion



Akses Vaskuler



: Cimino



Vascular access



Alergi



: None



Allergies



Berat Badan Kering



: 58 kg



Dry weights



Heparinisasi



: minimal



Heparinization



Kenaikan BB Intradialisis



: 2 - 3 kg



Weights gain Intradialysis



Komplikasi Selama HD Intradialysis complications



: Headache



Diet



Low Salt



Keterangan Lain Further Comment



:



Obat yang dikonsumsi saat ini : Present Medication



Diet :



Obat durante HD : Recormon 5000 u



Peridialysis Medication



HASIL PEMERIKSAAN LABORATORIUM LABORATORY RESULT



TANGGAL DATE :



BUN/ Urea Creatinin



: 92,39 : 15,63



Blood Sugar Fe



: 121 :



Hb



: 8,8 g/dl



Ferritin



:



Na



: 137,1



Transferrin saturation



:



K HCO3+ Ca



: 4,93 : :



Albumin PTH HBs Ag



► : : Negatif



PO4 Phospor



: :



Anti HCV Anti HIV



: Negatif : Negatif Surabaya, 10 Desember 2012 Renal Physician



( dr Chandra Irwanadi SpPD-KGH)



(PHC General Hospital Surabaya) Jl. Prapat kurung Selatan No.1 Surabaya – Indonesia. Phone +62 31 3294801, Fax. +62 31 3294804



NAME



:



Mr/Mrs



AGE



:



years old



SEX



: Male/ Female



REG. NUMBER



:



Recent Address



:



TRAVELLING DIALYSIS Primary Diagnosis



:



Secondary Diagnosis



:



History



:



Date of Beginning Dialysis : PRESENT TREATMENT Recent Blood Pressure



Date of Last Dialysis :



Sistole : Diastole :



mmHg mmHg



Dialysis Frequency



:



x/ week



Mean/ Optimal blood flow



:



Rpm



Place of Dialysis



: Center/Home trained



Duration per Dialysis



:



Composition of Dialysate



:



Hepatitis sero marker



: Negative/Positive



Type of used Dialyzer



:



History of Blood Transfusion



: Yes/ Never



Vascular access



:



Allergies



:



Dry weights



:



Kg



Weights gain Intradialysis



:



Kg



Left/ Right Heparin/ LMWH



:



unit/hour



: Intradialysis complications



: Peridialysis Medication



Diet : Further Comment



:



Present Medication



:



LAST LABORATORY RESULT BUN/ Urea :



DATE : Blood Sugar



:



Creatinin



:



Fe



:



Hb level



:



Fe binding capacity



:



Na



:



Transferrin saturation



:



K



:



Ferritin



:



HCO3+



:



PTH



:



Ca



:



HBs Ag



:



PO4



:



Anti HCV



:



Anorganic Phospor



:



Anti HIV



:



Albumin



:



nPCR



:



ALT



:



URR



:



AST



:



Kt/V



: Surabaya, ………………….. 20…. Renal Physician:



Chandra Irwanadi, dr, SpPD-KGH



Nama



: Ny. Umi Ruwaicha



Name



TRAVELLING DIALYSIS Diagnosa Utama



: CKD STG V



Primary Diagnosis



Diagnosa Sekunder ( P H C Hospital: SHipertensi urabaya)



Secondary Diagnosis Jl. Prapat kurung Selatan No.1 Surabaya – Indonesia. Phone +62 31 3294801, +62 31 3294804 Riwayat Penyakit : Fax. Hipertensi History



Umur



:47 th



Age



Jenis Kelamin



: Female



Sex



Nomer Register



: 92108



Reg. Number



Alamat Address



: Jl. Merpati 173 Sampang



Tanggal Awal HD



Tanggal Terakhir HD



Date of Beginning Dialysis : 21-11 2012



Date of Last Dialysis : 30-11-2012



PRESENT TREATMENT Tekanan Darah



Frekwensi HD



Sistole : 140 - 190 Diastole : 70 - 100



Blood Pressure



: 2x/minggu



Dialysis Frequency



Optimal Blood Flow



: 200 Rpm



Mean/ Optimal blood flow



Tempat dilakukan HD



: Rumah sakit



Place of Dialysis



: 4 - 4,5 jam



Lamanya HD Duration per Dialysis



Komposisi Dialisat



: Bicarbonat



Composition of Dialysate



: Negative



Sero Marker Hepatitis Hepatitis sero marker



Tipe Dializer



: F7 HPS Fresenius



Type of used Dialyzer



Riwayat Transfusi Darah



: None



History of Blood Transfusion



Akses Vaskuler



: Three Lument



Vascular access



Alergi



: None



Allergies



Berat Badan Kering



: Belum bisa timbang



Dry weights



Heparinisasi



: Normal



Heparinization



Kenaikan BB Intradialisis



: -



Weights gain Intradialysis



Komplikasi Selama HD Intradialysis complications



: Hipertensi



Diet



Low Salt



Keterangan Lain Further Comment



:



Obat yang dikonsumsi saat ini : Present Medication



Diet :



Obat durante HD : Sohobion 5000 inj



Peridialysis Medication



HASIL PEMERIKSAAN LABORATORIUM LABORATORY RESULT



TANGGAL DATE :



BUN/ Urea Creatinin



59,72 ( pre HD 30/11/2012 ) 8,01 ( pre HD 30/11/2012 )



Blood Sugar Fe



: :



Hb



9,8



Ferritin



:



Na



133,2 ( 27/11/2012)



Transferrin saturation



:



K HCO3+ Ca



4,41



Albumin PTH HBs Ag



: : : Negatif



PO4 Phospor



: :



Anti HCV Anti HIV



: Negatif : Negatif



( 27/11/2012) ( 27/11/2012)



Surabaya, 1 Desember 2012 Renal Physician ( dr. Chandra Irwanadi SpPD- KGH)