Module

GERIATRY & GROWTH DEVELOPMENT SYSTEMMEDICAL FACULTYHASANUDDIN UNIVERSITY

STUDENTS’ MODULE

Given to 6th Semester Medical Students OfHasanuddin University

Created Bydr. Femi Syahriani, SpPD.dr. Wasis Udaya, SpPD.

GERIATRY & GROWTH DEVELOPMENT SYSTEMMEDICAL FACULTY

HASANUDDIN UNIVERSITY2011

INTRODUCTION

These modules are designed for the sixth semester students of Medical Faculty, as part

of the Geriatry and Growt Development System Curriculum. The module is completed

with scenarios that represent the signs and symptoms, as well as the risk factors which

frequently found in certain diseases among elderly people. The students are expected

to discuss not only the chief complain (as the main problem) of the scenario, but also

everything that considered asscociated to it, e.g. diseases’ pathomechanism in which

the students must discuss about the related anotomy, physiology and biochemical

process. The ultimate goal is directed more to the problem solving process rather than

the diagnosis.

The students are expected to be able to explain all aspects about normal diuresis

control, the changing process in the urinary tract due to aging process, the causative

factors and its cathegorization, and the treatment of urine incontinence for elderly

people.

Prior to the PBL process, both students and turors must read the goals and objectives

of the module to assure the prosess is accomplished according to the designated

objectives, as well as to achieve the desired competition. Discussion materials can be

obtained either from lecture handouts or other references provided by the lecturers or

tutors.

We strongly hope that this module can be very useful in helping the students in solving

the problem of urine incontinence and fall; able to confirm the dignosis and becoming

well knowledgable for the treatment and prevention.

Makassar , February 2011

Creative Team,Geriatry & Growth Development System

1. After reading the above scenarios thoroughly, the students must discuss thecases in a leader-led group discussion. Both the leader and the secretary arechosen by the students themselves.

2. Conducting a self study by providing data/information that will support thediscussion

3. Conducting a self-coached group discussion (without tutor)4. Consulting the problems revealed during the PBL to the experts for a better

understanding5. Attending provided experts’ lecture for unsolved problems

In a leader-led group discussion, the students are expected to solve the problems in thescenarios by conducting these following 7 jumps of problem solving process:

1. Clarifying the un-clear terms stated in the scenario, then defining thekeywords/key statement(s)

2. Identifying the basic problem of the scenario, by creating some leadingimportant questions

3. Analizing the problems by answering the above questions4. Classifying the answers5. Developing study objectives that must be achieved by the students during the

case discussion6. Looking for other supporting information related to the above cases7. Reporting the result of discussion and synthesizing the other identified

informationImportant Notes:

Step 1 to 5 are conducted during the first coached-tutorial with the tutor Step 6 is a self study; performed out of the class either by a group discussion or

by student solely, which will then be discussed together in an un-coachedgroup

Step 7 is conducted during the second coached-tutorial with the tutor

1. First meeting in a general class lecture; the lecture delivers a one waycommunication of lecturing followed with asking question sessionObjective: explaining the module and how to complete the provided tasks developing several discussion groups. During this first meeting, the modules

will also be distributed to the students.

2. Second meeting: self-study. Objectives: choosing a group leader and secretary

STUDENTS’ TASKS

PROBLEM SOLVING PROCESS

ACTIVITIES SCHEDULE

brain storming for step 1 to 3 distributing tasks for members of the group

3. Third meeting: a leader-led group discussion, facilitated by a tutor. Objective: toreport the self-study result and accomplish the PBL process to the fifth step

4. Self-study, either together with other students in a group discussion or solely.Objective: Collecting other new necessary information

5. Fourth meeting: a leader-led group discussion, facilitated by a tutor. Objective:reporting the last discussion result as well as for synthesizing the recently identifiedinformation

6. Fifth meeting (last one): conducted in a general class, applying a panel discussionform, in which students report the final results of each group’s discussion, andclarifying things that remain unsolved by the groups.

PERTEMUAN

I II III IV V VI VII1st MeetingExplanation

2nd

Meeting;self study(BrainStorming)

1st TutorialCollectinginformation,analyzingandsynthesizing data

SelfStudy

Practical Work,CSL

Lecture,Consultation

2ndTutorial(Reportinganddiscussing)

LastMeeting(Reporting)

1. A leader-led group discussion, facilitated by a tutor2. A leader-led group discussion, without a tutor3. Experts consultation4. Experts lecture in a general class5. Self-study activities in the library with books, magazines, slides, tape

recorder, video or the internet.6. Conducting practical work of Anatomy, Physiology, Biochemistry, Histology,

Pathology Anatomy, Microbiology, Clinical Pathology and Nutrition

TIME-TABLE

STUDY STRATEGIES

A. Hand outs and JournalsAnatomyHistologyBiochemistryPathology AnatomyMicrobiology1. Baron, JD; Peterson, LR; Finegold, SM: Bailey & Scott’s Diagnostic

Microbioloy, 9th edition, Mosby, Sydney, 1994.2. Brooks, GF; Butel, JS; Morse, SA: Jawezt, Melnick, & Adelberg’s Medical

Microbiology, 23rd Edition, International Edition, McGraw-Hill, Kuala Lumpur,2004.

3. Cohen, J., et all: Infectious Diseases, Volume 1, 2nd Edition, Mosby, Sydney,2004.

4. Ryan, KJ; Ray CG: Sherris Medical Microbiology, an Introduction to InfectiousDiseases, 4th Edition, McGraw-Hill, Singapore, 2004.

5. Joklik, WK; Willett, HP; Amos, DB; Wilfret, CM: Zinsser Microbiology, 20thEdition, Appleton & Lange, Connecticut, 1992.

6. Virella, G.: Microbiology and Infectious Diseases, 3rd Edition, Wlliams &Wilkins, Tokyo, 1997.

Geriatry1. Brocklehurst JC, Allen SC. Urinary Incontinence. Geriatric Medicine for

Student. 3rd ed. Churchill Livingstone; 1987. 73-91.2. Boedhi-Darmojo R. Teori Proses Menua. Dalam : Buku Ajar Geriatri. Ed 2,

Edit oleh R.Boedhi-Darmojo & Hadi Martono. Balai Penerbit FakultasKedokteran Universitas Indonesia, 2000; 3-12.

3. Cordts GA. Urinary Incontinence. In: Forciea MA, et al. Editors. GeriatricSecrets. Philadelphia: Hanley & Belfus Inc; 1996. 185-93.

4. Fonda D. Management of The Incontinent Elderly Patient. In: Update inGeriatric Medicine

5. Kane RL, Ouslander JG, Abrass IB. Essential of Clinical Geriatrics. New York.McGraw-Hill; 1994. 145-96.

6. Konety B, Tewari Pasien, Narayan P : Urinary Incontinence. In: Lonergan ET.Editor. Geriatrics. Stamford Conecticut: Appleton & Lange. 1996. 489-96.

7. Lapitan MCM. The Role of The Pelvic Floor in Urinary Incontonence andOther Urological Conditions. Medical Progress. 1999; 26 : 27-32.

8. Lim PHC. Overactive Bladder. Medical Progress. 2000; 27: 17-23.9. Setiati S. Pedoman Pelaksanaan Inkontinensia Urin Pada Pasien Geriatri.

Dalam: Pedoman Pengelolaan Kesehatan Pasien Geriatri. Editor SoejonoCH, Setiati S, Wiwie MSN, Silaswati S. Pusat Informasi da Penerbitan BagianIlmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia. 2000: 85-102.

10.Pranarka K. Inkontinensia. Dalam : Buku Ajar Geriatri. Ed 2, Edit olehR.Boedhi-Darmojo & Hadi Martono. Balai Penerbit Fakultas KedokteranUniversitas Indonesia. 2000; 177-188.

OTHER SOURCES OF INFORMATION AND REFERENCELIST

Paediatrics

1. Soetjihningsih. Tumbuh kembang anak. Ranuh G Ed. Jakarta :EGC, 1995.2. Sularyo TS. Pertumbuhan linier anak dan upaya pemantauanya dengan

minat perawakan pendek/terlalu pendek. Dalam: Rukman Y, BatubaraYose, Tridjaja B, Eds. Masalah penyimpangan pertumnbuhan somatik padaanak dan remaja. PKB ilmu kesehatan anak XXVIII, Jakarta 1993.

3. Tanuwidjaya S. Konsep tumbuh dan kembang. Dalam : Narendra MB,Sularyo TS, Soetjiningsih, Suyitno H, Ranuh IG. Eds. Tumbuh kembang anakdan remaja. Jakarta. Sagung Seto, 2002,1-13.

4. Needlmn RD. Growth and development. Dalam : Behrman RE, KliegmanRM, Jenson HB, Eds. Nelson textbook pediatrics 17 th, Philadelphia,WBSaunders 2004:23-65

5. Pedoman pelaksanaan stimulasi, deteksi dan intervensi dini TumbuhKembang Anak di tingkat pelayanan dasar. Depkes RI 2005

6. Tumbuh kembang-pedsos. Dalam : Pusponegoro HD, Hadinegoro SR,Firmanda D, Tridjaja B, Eds.Standar Pelayanan Medis kesehatan anakEdisi1: IDAI; 2004. 367-369.

7. Levine DA. Growth and development. Dalam : Behrman RE, Kliegman RM,Jenson HB, Eds. Nelson textbook pediatrics 5 th, Philadelphia: Saunders2004;23-65

8. Soedjatmiko. Stimulasi dini untuk bayi dan balita. Dalam : Pulungan AB,Hendarto A, Hegar B, Oswari H. Eds. Continuing Profesional DevelopmentNutrition Growth-development. IDAI Jaya 2006, 27-46.

B. Lecture HandoutC. Other source : VCD, Film, Internet, Slide, TapeD. Lecturers

No. NAMA DOSEN BAGIAN HP / FLEXI01. Prof.Dr.dr.Edu S.Tehupeiory, SpPD-KR Penyakit Dalam / Reumatologi 081524187006 /

502094802. Prof.dr.H.Junus Alkatiri, SpPD-KKV, SpJP(K), FIHA Kardiologi / Penakit Dalam 08124151234 /

081625081603. Prof.dr. H.A.M. Akil, SpPD-KGEH Penyakit Dalam /

Gastroenterohepatologi04. Prof.dr.H.Achmad M.P, SpB,SpBU(K) Bedah Urologi

05. Prof.dr.H.Harsinen Sanusi, SpPD-KEMD Penyakit Dalam / Endokrin-Metabolik

06. Prof.Dr.dr.H.Syakib Bakri, SpPD-KGH Penyakit Dalam / Ginjal-Hipertensi

07. Prof.dr. Piter Kabo, PhD, SpFK, SpJP Farmakologi dan Kardiologi

08. Dr. H.M.Junus Patau, SpP, SpPD-KP Penyakit Dalam / Pulmonologi

09. Dr. H.A.Fachruddin Benyamin, SpPD-KHOM Penyakit Dalam / Hematologi-Onkologi

0811440252 /081342945932

10. dr. H.Wasis Udaya, SpPD Penyakit Dalam / Geriatri 08159912601 /5766036

11. Dr.dr. Hj.Nurpudji Astuti Taslim, MS Gizi Klinik 0811443856

12. Dr.dr. A.Wardihan Sinrang, MS, SpAnd Fisiologi

13. Prof. dr. Rosdiana Natsir, PhD Biokimia

14. dr. H.Tahir Abdullah, MSc IKM / IKP

15. dr.H.A.Jayalangkara Tanra, PhD, SpKJ Psikiatri

16. dr. Asmaun Nadjamuddin, SpRM Rehabilitasi Medik 081342585728

17. dr. Muhammad Akbar, PhD, SpS Neurologi 0811415252

18. dr. A. D a r w i s, SpRad Radiologi

19. dr. Henry Yurianto, SpOT Bedah Orthopedi

20. dr. Hj.Habibah S. Muhiddin, SpM Ilmu Penyakit Mata

21. dr. H. H a m z a h , SpM Ilmu Penyakit Mata

22. dr. Hj. Farida Tabri, SpKK Ilmu Penyakit Kulit & Kelamin

23. Prof. Dr.dr. Syarifuddin Rauf, SpA(K) Ilmu Kesehatan Anak 081141110924. dr. J. S. Lisal, SpA(K) Ilmu Kesehatan Anak 081141805325. dr. Ny. Djuahariah A. Madjid, SpA(K) Ilmu Kesehatan Anak 081144661626. dr. Martira Maddeppungeng, SpA Ilmu Kesehatan Anak 081342903666

E. REFERENCES

Boedhi-Darmojo R. Teori Proses Menua. Dalam : Buku Ajar Geriatri. Ed 2, Edit olehR.Boedhi-Darmojo & Hadi Martono. Balai Penerbit Fakultas Kedokteran UniversitasIndonesia, 2000; 3-12.

Campbell JA, Borrie MJ, Spears GF. Risk Factor for Falls in A Community BasedProspective Study of People 70 years and Older. J Gerontology Medical Sciences,44:M112-117, 1987.

Isbagio H. Perbedaan antara osteoporosis dengan gangguan muskuloskeletal lainnya.Dalam : Naskah Lengkap Simposium Diagnostik dan Penatalaksanaan TerpaduOsteoporosis. FKUI, Jakarta, 1994.

Kane RL, Ouslander JG, Abrass IB. Instability and Falls. In : Kane RL ed; Essentials ofClinical Geriatrics. 3rd ed. Mc Graww-Hill Inc, New York, 1994; 197-219.

Kane RL, Ouslander JG, Abrass IB. Clinical Implications of The Aging Process. In : KaneRL, Ouslander JG, Abrass IB (eds). Essentials of Clinical Geriatrics. New York. Mc Graw-Hill, 1994 ; 3-17.

Setiati S. Proses Menua dan Implikasi Kliniknya. Dalam : Pedoman Pengelolaan KesehatanPasien Geriatri. Ed 1. Edit : Soejono CH, Setiati S, Wiwie MS, Silaswati S. Pusat Informasidan Penerbitan Bagian Ilmu Penyakit Dalam FKUI, 2000 ; 6-15.

Soejono CH. Instabilitas dan Jatuh. Dalam : Pedoman Pengelolaan Kesehatan PasienGeriatri. Ed 1. Edit : Soejono CH, Setiati S, Wiwie MS, Silaswati S. Pusat Informasi danPenerbitan Bagian Ilmu Penyakit Dalam FKUI, 2000 ; 109-114.

Tinetti MR. Falls. In : Hazzard WR, Andres R, Bierman EL, Blass JP ed ; Principles ofGeriatric Medicine and Gerontology, 2nd ed. Mc Graww-Hill Inc, New York, 1992; 1192-1199.

Van der Cammen TJM, Rai GS, Extonsmith AN. Instability and Falls. In : Manual ofGeriatrics Care. Churchill-Livingstone, Edinburg, 1991.

Williams ME. Approach to Managing the Elderly Patient. In : Hazzard WR, Bierman EL,Blass JP, et al (eds). Principles of Geriatric Medicine and Gerotology. New York. Mc Graw-Hill Inc, 1999 ; 249-253.


STUDENTS’ MODULE

FALLS & URINE INCONTINENTIA


Created Bydr. Femi Syahriani, SpPD.dr. Wasis Udaya, SpPD.

GERIATRY SYSTEMMEDICAL FACULTY


MODULEF A L L S

After learning the module, the students are expected to have the ability in explaining the

principal concept of knowledge related to the process that might develop fall among the

elderly, as well as the possible risk factors both intrinsic and extrinsic factors.

CASES

SCENARIO I

A 73 year old woman was hospitalized due to pain at her right hip, leading to pain

sensation whenever she walked. She has been having the problem since 3 days ago,

it started when she fell in sitting position in the toilet. She had the back bending

posture since last year. She was in medication for diabetes, hypertention, heart

disease and rheumatic. Four years ago, she had stroke attack.

.

SCENARIO II

A 69 year old man came to a hospital because he can not move both of his legs. Prior

to this, he was sliped and landed on a sitting position. He claimed that he did not see

the spilled water ahead of him. It has been a week since he has been coughing and

difficult in breathing. He lost his appetite, but having no fever. All this time he was in

medication for diabetes and hypertention.

STUDY GOALS

MODULEURINE INCONTINENTIA

After learning the module, the students are expected to have the ability in in solving the

problem of urine incontinensia; able to confirm the dignosis and become well

knowledgable for the treatment and prevention.

CASESScenario 1

A 79 year old man was taken to PUSKESMAS with frequent urinate but less in

quantity. Eventough the prosess took a long time, most of the time he felt unsatisfied.

This condition started 7 days ago. He also complained about knee pain that he had

been having for some times.

According to the family, the man was always in a bad temper, easy forgetting lots of

things which he just did. He was in medication for diabetes, hypertention, heart

disease and rheumatic for about 7 years now. Three years ago, he had stroke attack.

Scenario 2A 68 year old woman was taken to PUSKESMAS by her family. According to the

family, she frequently went to the toilet for peeing. She did not complain of any pain

during urinate. It had been a week since she started to cough and bit hard in cathing

up her breath, her appetite lost significantly, no fever.

She had diabetes and hypertention, and she was in medication for both.

STUDY GOALS


STUDENTS’ MODULE

IMPAIRMENT IN CHILDREN GROWTH &DEVELOPMENT


Created By :

Prof.dr.Ny Djauhariah A Madjid SpA(K)dr.Martira M Maddeppungeng SpA

GERIATRY SYSTEMMEDICAL FACULTY


INTRODUCTION

These modules of Impairment in Children Growth and Development & EnergyProtein Malnutrition are designed for the sixth semester students of UNHAS Medical

Faculty, as part of the Geriatry and Growth Development System Curriculum.

By using the module of Impairment in Children Growth and Development, the

students are expected to comprehend the children growth and develoment process from

the newborn until adoloscent, factors thet intervene the process, as well as

understanding the importance of monitoring the process for early impairment detection.

PBL process includes activities like tutorial meetings, self study for information

gathering from the experts, text books, journals in the library or through the internet,

writing and presenting final report as the result of the PBL discussion process.

We strongly hope that through this PBL the students will be more active to search for

solutions to overcome the challenges presented in the scenarios that are most likely be

found in the community.

Makassar , February 2011

Creative Team,Geriatry & Growth Development System

MODULE

IMPAIRMENT IN CHILDREN GROWTH ANDDEVELOPMENT

GENERAL INSTRUCTIONAL OBJECTIVESAfter learning the module, the students are expected to have the ability in explaining the

growth and development process, defining normal children growth and development,

defining children nutritional status, planning children vaccination and identifying any

impairment in growth and development in children.

SCENARIO :

A, a boy was taken to Puskesmas in Desember 5th 2009 due to overnight fever. Heborn in February the 25th, 2009; supported by a midwife, hardly breathing when he wasfirst delivered, with weak muscle tonus, birth weight (BW) 3000 grams, birth length (BL)49 cm, head circumference (HC) 35 cm. The last 2 months consequtive weighinrecords: 6100 grams dan 6300 grams, with HC 44 cms. For daily meal the baby wasfed with rice and vegetables, tofu, tempe, and sometimes egg. Starting from the age of3 months, he consumed formula milk, bananas and baby porridge because he criedmost of the time.

He got BCG immunization when he was 2 months old; 4 times polio vaccine; B Hepatitisvaccine twice, in the age of 40 days and 3 months; DPT when he was 2 and 6 monthsold.

The baby was able to crawl, but not yet sit and stand by him self. Sometimes mumbled,not able to hold jingling toys with his hands. He responded to sound, and able to showthe direction of the sound source, can not feed him self with biscuits, and do not knowhow to play peek-a-boo. His mother was elementary school graduate only. Toysavailable at home: jingling toys, dolls, a three wheel bicycle. The mother never talkedmuch.

MODULEMALNUTRISI ENERGI PROTEIN

GENERAL INSTRUCTIONAL OBJECTIVES

After learning the module, the students are expected to have the ability in explaining the

definition, etiology, pathogenesis, clinical features, required laboratory tests and other

supporting examinations, diagnosis and complication, other accompanying

diseases/conditions, management, and prevention of Malnutrition condition in general

and Protein and Energy Malnutrition condition in particular.

SCENARIO:

A 1 year old and 11 month boy was hospitalized due to fever and recurrent cough

during the last 6 months, and now showing shortness of breathing. He also showed

less apetite, and swelling of lower legs and stomach for the last 1 month. He had

frequent diarrhea, sometimes accompanied with bloody and mucoid stool. The parents

were economically struggle. Contact history with TB patient was not clear.

Physical examination findings: The child looked very sick with very bad nutritional

status, apthy, body weight 8.1 kgs, body height 76 cms, looked dyspnoeic, nose tip

breathing, tachypnoe, cyanosis. Lung: wet ronchy, but not clear; Heart: normal; face,

palm and feet looked pale; Liver: 3 cms below ribs curve; Spleen: S1, edema dorsum

pedis, pretibial and upper legs, ascites. Dehydration score: 10.

Module

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