tag:blogger.com,1999:blog-20193079172341477752024-02-20T11:42:21.577-08:00Asuhan keperawatanMaryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.comBlogger94125tag:blogger.com,1999:blog-2019307917234147775.post-10662587457002213172012-03-03T21:50:00.001-08:002012-03-03T21:50:21.727-08:00<br />
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<b><span lang="SV">ABORTUS</span></b></div>
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<b><span lang="SV"><br /></span></b></div>
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<b><span lang="SV">BAB I<o:p></o:p></span></b></div>
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<b><span lang="SV">PENDAHULUAN<o:p></o:p></span></b></div>
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<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="SV">Latar Belakang<o:p></o:p></span></b></li>
</ol>
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<span lang="SV">Penyakit perdarahan pada kehamilan adalah suatu
keadaan kedaruratan dalam kedokteran. Mortalitas maternal menurun secara
bermakna pada tahun- tahun terakhir, tetapi perdarahan masih tetap menjadi
penyebab kematian maternal yang utama
(Suresh, Kinch, 1991). Penatalaksanaan secara tim perlu </span><span lang="SV">dilakukan untuk
menyelamatkan kehidupan ibu dan janin.<o:p></o:p></span></div>
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<span lang="SV">Perdarahan pada kehamilan awal membahayakan ibu dan merupakan masalah
bagi dokter yang merawat. Gangguan perdarahan yang sering timbul pada awal
kehamilan salah satunya adalah abortus.<o:p></o:p></span></div>
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<span lang="SV">Perdarahan selama kehamilan dapat dianggap sebagai suatu keadaan akut
yang dapat membahayakan ibu dan anak, sampai dapat menimbulkan kematian.
Sebanyak 20 % nita hamil pernah mengalami perdarahan pada awal kehamilan dan
sebagian mengalami abortus. Hal ini tentu menimbulkan ketidakberdayaan dari
wanita sehingga ditinjau dari suatu kesehatan akan sangat ditanggulangi untuk
meningkatkan keberdayaan seorang wanita. Ada beberapa keadaan yang dapat
menimbulkan keadaan perdarahan pada awal kehamilan seperti implantasi ovum,
karsinoma serviks, abortus, molahidatidosa. Perdarahan pada kehamilan muda
adalah perdarahan pervagina pada kehamilan kurang dari 2 minggu. <o:p></o:p></span></div>
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<span lang="SV">Setiap perdarahan dalam kehamialn harus dianggap sebagai keadaan akut
berbahaya dan serius dengan resiko tinggi karena dapat menimbulkan kematian ibu
dan janin.sebagian mengalami abortus.hal ini akan menimbulkan ketidak berdayaan
dari wanita sehingga ditinjau dari segi kesehatan akan sangat akan sngat ditanggulangi
untuk untuk meningkatkan keberdayaan seorang wanita.<o:p></o:p></span></div>
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<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="SV">Tujuan <o:p></o:p></span></b></li>
</ol>
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<!--[if !supportLists]--><b><span lang="SV">1.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="SV">Tujuan Umum<o:p></o:p></span></b></div>
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<span lang="SV">Mahasiswa mampu memahami kelainan pada ibu hamil yang berhubungan dengan
abortus<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="SV">2.<span style="font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="SV">Tujuan Khusus <o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="SV">a.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">menjelaskan definisi abortus<b><o:p></o:p></b></span></div>
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<!--[if !supportLists]--><span lang="SV">b.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">menyebutkan etiologi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">c.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">majelaskan patofisiologi dari abortus<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">d.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">menyebutkan dan menjelaskan penatalaksanaan pada
abortus<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">e.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">membuat dan mengkaji asuhan keperawatan paklien
dengan abortus<o:p></o:p></span></div>
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<span lang="SV"><o:p> </o:p></span><span style="line-height: 150%;"> </span></div>
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<b><span lang="SV">BAB II<o:p></o:p></span></b></div>
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<b><span lang="SV">TINJAUAN PUSTAKA<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="SV">A.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">DEFINISI<o:p></o:p></span></div>
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<span lang="SV">Abortus didefinisikan sebagai
keluarnya janin sebelum mencapai viabilitas. Karena devinisi viabilitas
berbeda-beda diberbagai negara, WHO merekomendasikan bahwa janin viabel apabila
masa gestasi telah mencapai 22 minggu atau lebih, atau apabila berat janin 500
gr atau lebih.<o:p></o:p></span></div>
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<span lang="SV">Abortus adalah suatu usaha
mengakhiri kehamilan dengan dengan mengeluarkan hasil pembuahan secara paksa
sebelum janin mampu bertahan hidup jika dilahirkan.<o:p></o:p></span></div>
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<span lang="SV">Abortus adalah berakhirnya
kehamilan melalui cara apapun sebelum janin mampu bertahan hidup.<o:p></o:p></span></div>
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<span lang="SV">Abortus adalah keluarnya janin
sebelum mencapai viabilitas. Dimana masa getasi belum mencapai 22 minggu dan
beratnya kurang dari 500gr (Derek liewollyn&Jones, 2002).<o:p></o:p></span></div>
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<span lang="SV">Jenis- jenis abortus dapat
dibagi sebagai berikut :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus apontan : apabila abortus terjadi
tanpa tindakan mekanis atau medis untuk mengosongkan uterus, disebabkan oleh
sebab- sebab alami.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">a.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus iminens(keguguran mengancam) :
abortus ini baru mengancam dan masih ada harapan untuk mempertahankannya, pada
abortus ini terdapat nyeri akibat kram pada abdomen bawah atau nyeri pada
punggung bawah, tetapi bisa juga tidak.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">b.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus incipiens : abortus ini sudah
berlangsung dan tidak dapat dicegah lagi.abortus ini terjadi ketika ada
pembukaan serviks atau ketuban pecah disertai perdarahan dan nyeri pada bagian
abdomen bawah atau pada punggung.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">c.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortu inkompletus (keguguran tidak
lengkap) : sebagian dari buah kehamilan telah dilahirkan tapi sebagian (
biasanya jaringan plasenta) masih tertinggal dalam raahim, yang akan
menyebabkan perdarahan yang bertambah parah atau infeksi, terutama jika aborsi
terjadi pada trimester ke II<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">d.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus kompletus : keguguran lengkap<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">e.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Missed abortus ( keguguran tertunda ) :
keadaan dimana janin telah mati selama 22
minggu tetapi tertahan didalam rahim selama 2 bulan atau lebih setelah
janin mati.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">f.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Aburtus Habitualis : keguguran berulang ulang, terjadi pada
wanita yang telah mengalami abortus lebih dari tiga kali. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">g.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus infeksiosus dan abortus septik :
abortus yang disertai infeksi pada genetalia, sedang abortus septik adalah
abortus infeksius berat disertai penyebaran kuman atau toksin kedalam peredaran
darah atau peritonium.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus provocatus (disengaja ,
digugurkan) :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">a.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus provocatus therapeuticus adalah
pengguguran kehamilan, biasanya dengan alat-alat dengan alasan bahwa kehamilan
membahayakan, membawa maut bagi ibu, misalnya karena ibu menderita penyakit
berat. <o:p></o:p></span></div>
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<span lang="SV">Pengguguran kandungan buatan
karena indikasi medik disebut abortus terapeutik (Prawirohardjo, S, 2002).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">b.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus provocatus criminalis adalah
pengguguran kehamilan tanpa alasan medis yang syah dan dilarang oleh hukum.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">B.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">ETIOLOGI DAN FAKTOR RESIKO<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Faktor ovofetal yang menyebabkan abortus
adalah kelainan pertumbuhan janin dan kelainan pada plasenta. Penyebab kelainan
pertumbuhan janin ialah kelainan kromosom, lingkungan kurang sempurna, dan
pengaruh dari luar. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Kelainan plasenta disebabkan endarteritis
pada villi koriales yang menghambat oksigenisasi plasenta sehingga terjadi
gangguan pertumbuhan bahkan menyebabkan kematian (Prawirohardjo, S, 2002).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">3.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Keadaan ibu yang menyebabkan abortus
antara lain: <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">penyakit
Ibu seperti pneumonia, tifus abdominalis, pielonefritis, malaria, <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV"> toksin, bakteri, virus, plasmodium masuk ke janin menyebabkan
kematian sehingga terjadi abortus, <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">penyakit
menahun, dan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV"> kelainan traktus genitalis, seperti
inkompetensi serviks, retroversi uteri, mioma uteri, dan kelainan bawaan uterus
(Prawirohardjo, 2002).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">4.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">faktor-faktor hormonal, misalnya penurunan
sekresi progesteron diperkirakan sebagai penyebab terjadinya abortus pada usia
kehamilan 10-12 minggu, yaitu pada saat plasenta mengambil alih fungsi korpus
luteum dalam produksi hormon.<o:p></o:p></span></div>
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<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt;"><span lang="SV">PATOFISIOLOGI<o:p></o:p></span></li>
</ol>
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<span lang="SV">Pada
abortus terjadi perdarahan desidualis, Pelepasan embrio parsial atau komplit
akibat perdarahan kecil didalam desidua. Ketika terjadi kegagalan fungsi
plasenta, uterus mulai berkontraksi sehingga proses abortus mulai. Jika terjadi
sebelum minggu kedelapan, embrio defektif yang tertutup vilidan desidua
cenderung dikeluarkan dalam gumpalan yang disebut blighted ovum, walaupun
sedikit konsepsi dapat tertahan dalam uterus maupun serviks. <o:p></o:p></span></div>
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<span lang="SV">Perdarahan
uterus terjadi sewaktu proses pengeluaran, antara minggu kedelapan dan ke empat
belas, mekanisme diatas dapat terjadi. Atau membran ketuban dapat ruptur
sehingga mengeluarkan janin yang cacat, tetapi gagal mengeluarkan plasenta.
Plasenta ini dapat menonjol di osteum serviks eksterna. Atau tetap melekat pada
dinding uterus. <o:p></o:p></span></div>
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<span lang="SV">Abortus ini
diikuti oleh perdarahan yang banyak. Antara minggu ke14 dan 22 janin biasanya
dikeluarkan dengan diikuti plasenta beberapa saat kemudian. Plasenta lebih
jarang tertahan. Biasanya perdarahan tidak berat, tetapi rasa nyeri dapat
hebat, sehingga menyerupai persalinan kecil<o:p></o:p></span></div>
</div>
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D. PATHWAS </div>
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<br /></div>
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<span lang="SV"><o:p> TERLAMPIR</o:p></span></div>
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<br /></div>
</div>
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<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt;">MANIFESTASI
KLINIS<o:p></o:p></li>
</ol>
</span>
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<!--[if !supportLists]--><span lang="SV">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus komplet<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">a)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Bercak perdarahan hingga perdarahan sedang<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Servik tertutupo atau terbuka.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">c)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Yterus lebih kecil dari ukuran normal<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">d)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Gejala sedikit atau tanpa nyeri perut
bawah.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus inkompli=et<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">a)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">setelah terjadi abortus dengan pengeluaran
jaringan, perdarahan berlangsung terus<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">sering servik tetap terbuka karena masih
ada benda didalam rahim yang dianggap korpus allenum, maka utherus akan
berusaha menelurkannya dengan kontraksi, tetapi kalau keadaan ini dibiarkan
lama, servik akan menutup kembali.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">c)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Perdarahan sedang hingga masif<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">d)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Gejala / tanda : kram/ nyeriakaut perut
bawah, dan ekspulsi sebagai hasil konsepsi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">3.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus incipiens<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">a)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">perdarahan banyak<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; mso-list: l3 level5 lfo1; tab-stops: list 81.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">nyeri akibat kontraksi rahim yang kuat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; mso-list: l3 level5 lfo1; tab-stops: list 81.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">c)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">akibat kontraksi rahim terjadi pembukaan <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">4.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus iminiens<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">a)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Perdarahan sedikit<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Nyeri melilit karena kontraksi tidak ada
atau sedikit sekali,kram perut bawah dan utherus lunak<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">c)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pada pemeriksaan dalam belum ada pembukaan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">d)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Serviks tertutup<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">5.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Missed abortion<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">a)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">rahim tidak membesar, malahan mengecil
karenaair ketubanmasrasi janain<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">buah dada mengecil kembali<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">c)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">amenore berlangsung terus<o:p></o:p></span></div>
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<br /></div>
<ol start="6" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt;"><span lang="SV">KOMPLIKASI<o:p></o:p></span></li>
</ol>
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<!--[if !supportLists]--><span lang="SV">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Perdarah pervorasi sering terjadi sewaktu
dilatasi dan kuretasi yang dilakukan oleh tenaga yang tidak ahli seperti bidan
atau dukun, stok pada abortus dapat disebabkan oleh perdarahan yang banyak
disebut syok hemorogik, dan infeksi berat atau sepsis disebuyt septik , infeksi
dan tetanus, payah ginjal<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pada missed abortion dengan retensi lama
hasil konsepsi dapat terjadi kelainan pembekuan darah ( kapita selekta
kedokteran ).<o:p></o:p></span></div>
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<br /></div>
<ol start="7" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt;"><span lang="SV">PEMERIKSAAN
DIAGNOSTIK<o:p></o:p></span></li>
</ol>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36.0pt;">
<b><i><span lang="IN">Pemeriksaan Diagnostik :<o:p></o:p></span></i></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="IN">1. Test HCG Urine Indikator kehamilan Positif <o:p></o:p></span></div>
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<span lang="IN">2. Ultra Sonografi Kondisi
janin/cavum ut terdapat
janin/sisa janin<o:p></o:p></span></div>
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<span lang="IN">3. Kadar Hematocrit/Ht Status
Hemodinamika Penurunan (<
35 mg%)<o:p></o:p></span></div>
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<span lang="IN">4. Kadar Hemoglobin Status
Hemodinamika Penurunan (< 10 mg%)<o:p></o:p></span></div>
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<span lang="IN">5. Kadar SDP Resiko
Infeksi Meningkat(>10.000
U/dl)<o:p></o:p></span></div>
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<span lang="IN">6. Kultur Kuman
spesifik Ditemukan
kuman<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
<ol start="8" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt;"><span lang="SV">PENATALAKSANAAN
<o:p></o:p></span></li>
</ol>
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<!--[if !supportLists]--><span lang="SV">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus imminiens :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">a)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tidak perlu pengobatan khusus atau tirah
baring total<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Jangan melakukan aktifitas fissik yang berlebihan
atau hubungan seks<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">c)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Jika terjadi perdarahan <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Berhenti : lakukan asuhan antenatal
seperti biasa, lakukan penilaian jika perdarahan terjadi lagi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Terus berlangsung : nilai kondisi janin (
uji kehamilan USG ), lakukan konfirmasi kemungkinan adanya penyebab lai,
perdarahan berlanjut, khususnya jika ditemukan utherus yang lebih besar dari
apa yang diharapkan, mungkib menunjukkan kehamilan ganda atau mola.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">3)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tidak perlu terapai hormonal ( estrogen
atau progresteron <br />
)atau tekolitik ( misalnya albutamol atau idometasin ) karena obat obat ini
tidak bisa mencegah abortus.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">abortus insipiens<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">a)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">jika usia kehamilan kurang 16 minggu
lakukan evaluasi uterus denga aspirasi vakum manual, jika evaluasi tidak dapat
segera lakukan : <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l3 level6 lfo1; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">persiapan untuk mengeluarkan hasil konsepsi
dari uterus<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">berikan ergromentin 0,2 mg IM ( dapat
diulang setelah 15 menit bila perlu ) atau misoprostol 400 mcg per oral ( dapat
diulang sesudah 4 jam bila perlu )<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">jika kehamilan lebih dari 16 minggu<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tungu ekspulsi spontan hasil konsepsi lalu
evaluasi sisa sisa hasil konsepsi.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Jika perliu lakuakn infus 20 unit
oksitosin dalam 500 ml cairan IV <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">c)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pastikan untuk memantau kondisi ibu
setelah penangan <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">d)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tirah baring total<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">e)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tindakan observasi yang cermat terhadap
bahan yang keluar dari vagina.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">f)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pengawasanm sering dan adekut terhadap
tanda tanda vital<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: list 54.0pt 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">3.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abortus inkomplet<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; tab-stops: list 63.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">a)</span><!--[endif]--><span lang="SV">Jika perdarahan tidak seberapa banyak dan
kehamilan kurang dari 16 minggu, evaluasi dapat dilakukan secara digital atau
dengan cunam ovum untuk mengeluarkan hasil konsepsi yang keluar melalui servik.Jika
perdarahan berhenti, beri ergrometrin 0,2 mg IM atau misoprostol 4090 mcg per
oral<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; tab-stops: list 63.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Jiak perdarahan banyak atau terus menerus
berlangsung dan usia kehamilan kurang dari 16 minggu , evaluasi sisa hasil
konsepsi dengan :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l3 level6 lfo1; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Aspirasi vacum manual <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l3 level6 lfo1; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Evaluasi dengan kuret tajam sebaiknya
hanya dilakukan jika aspirasi vakum manual tidak tersedia<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l3 level6 lfo1; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">3)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Jika evakuasi belum dapat dilakukan
segera, beri ergrometin 0,2 mg IM ( dapat diulang setelah 15 menit bila perlu )
atau misoprostol 400 mcg per oral ( dapat diulang sesudah 4 jam bila perlu )<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; tab-stops: list 63.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">c)</span><!--[endif]--><span lang="SV">Jika kehamilan lebih dari 16 minggu :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l3 level6 lfo1; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Berikan infus oksitosin 20 unit dalam 500
mi cairan IV ( garam fisiologik atau RL ) dengan kecepatan 40 tetes
permenit.sampai terjadi ekspulsi hasil konsepsi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l3 level6 lfo1; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Jika perlu berikan misoprostol 200 mcg
pervagina setiap 4 jam samapi terjadi ekspulsi hasil konsepsi ( max 800 mcg )<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l3 level6 lfo1; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">3)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Evaluasi sisa hasil konsepsi yang
tertinggal dalam uterus.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV">d)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pastikan untuk tetap memantau kondisi ibu
setelah penanganan, pada sebagian kasus, supresi laktasi mungkin di perlukan
untuk mencegah perdarahan lebioh lanjut.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: list 54.0pt 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">4.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">abortus komplit<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">a)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">tidak perlu evaluasi lagi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Observasi untuk melihat perdarah banyak<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">c)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pastikan untuk tetap memantau kondisi ibu
setelah penanganan <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">d)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Apabila terjadi anemia sedang, berikan
tablet sulfas ferrosus 600 mg per hari selama 2 minggu.Jika anemia berat
berikan transfusi darah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">e)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Konseling asuhan pasca keguguran dan
pemantauan lanjut.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt;">
<br /></div>
<ol start="9" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt;"><span lang="SV">ASUHAN
KEPERAWATAN<o:p></o:p></span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pengkajian<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l15 level1 lfo4; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">a.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pemeriksaaan fisik terhadap jumlah
perdarahan <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l15 level1 lfo4; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pemeriksaaan uteri<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l15 level2 lfo4; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tinggi dan besarnya tetap dan sesuai
dengan umur kehamilan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l15 level2 lfo4; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tnggi dan besarnya sudah mengecil<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l15 level2 lfo4; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">3)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Fundus tidak teraba diatas simpisis<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l15 level2 lfo4; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">4)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tinggi fundus 28 cm atau lebih<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l15 level2 lfo4; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">5)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">DJJ dalam batas tertentu atau dapat
menunjukkan takikardi/ bradikardi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l15 level2 lfo4; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">6)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Abdomen keras seperti papan uterus tegang
dan dengnan pembesaran simetris atau asimetris<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l15 level1 lfo4; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">c.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pemeriksan dalam<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l8 level1 lfo5; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Servik uteri menutup<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l8 level1 lfo5; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Servik sudah terbuka dan dapat teraba
ketuban dan hasil konsepsi dalam kavum uteri atau pada kanalis servikalis<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l8 level1 lfo5; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">3)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Besarnya rahim telah mengecil<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l8 level1 lfo5; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">4)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Konsistensinya melunak<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l15 level1 lfo4; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">d.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Kaji TTV <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l2 level1 lfo6; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">TD normal<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l2 level1 lfo6; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Nadi normal<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l2 level1 lfo6; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">3)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pernafasan normal<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l2 level1 lfo6; tab-stops: list 90.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">4)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Suhu normal.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pengkajian psikologi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level2 lfo6; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">a.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Cemas ketakutan <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level2 lfo6; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Gelisah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level2 lfo6; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">c.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Koping individu<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: list 54.0pt 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">3.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Pengkajian data yang mungkin muncul<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l11 level1 lfo7; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Nyeri dengna hemorogi retrop[lasenta<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l11 level1 lfo7; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">2)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Nyeri tekan nyata atau berat secara umum
atau local<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l11 level1 lfo7; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">3)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Nyeri punggung bawah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l11 level1 lfo7; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">4)<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Hipotensi, takikardi, perlambatan
pengisisn kapiler, kulit dingin dan lembab, pucat, pusing<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: list 54.0pt 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">4.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Masalah keperawatan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l11 level2 lfo7; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">a.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Nyeri akut <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l11 level2 lfo7; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Perubahan perfusi jaringa<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: list 54.0pt 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">5.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Diagnosa keperawatan <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l14 level1 lfo8; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">a.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Nyeri akut b/d kontraksi otot, dilatsi
serviks,<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l14 level1 lfo8; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">b.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Perubahan perfusi jaringan b/d hipovolemia<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: list 54.0pt 72.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">6.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">Tujuan interfensi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: list 72.0pt;">
<span lang="SV">Untuk mencegah kerusakan pada ibu dan
menyelamatkan kehamilan <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-bottom-style: none; border-collapse: collapse; border-color: initial; border-image: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; margin-left: -21.6pt; width: 672px;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 117.0pt;" valign="top" width="156">
<div align="center" class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt; text-align: center;">
<span lang="SV">Diagnosa
keperawatan<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 108.0pt;" valign="top" width="144">
<div align="center" class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt; text-align: center;">
<span lang="SV">Tujuan dan
kriteria hasil<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 128.7pt;" valign="top" width="172">
<div align="center" class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt; text-align: center;">
<span lang="SV">Intervensi<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.3pt;" valign="top" width="200">
<div align="center" class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt; text-align: center;">
<span lang="SV">Rasionalisasi<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 117.0pt;" valign="top" width="156">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level1 lfo9; tab-stops: list 21.6pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="SV">nyeri akut b/d kontraksi otot, dilatasi
serviks, trauma jaringan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">DS : <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Cemas
kesakitan, gelisah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">nyeri
dengan memorasi plasenta<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">nyeri
tekan nyata/berat scara umum /local<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">nyeri
punggung bawah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">mual<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">DO :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Hipotensi
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">takikardi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">perlambatan
pengisian kapiler <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">kulit
dingin dan lambat.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">Perubahan perfusi jaringan
b/d hipovolemi.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">DS :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Melaporkan
adanya perdarahan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Mual
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV"> Muntah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">DO : <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Perdarahan
DJJ <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Hipotensi
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Takikardi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Suhu
meningkat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Perdarahan
lebih 500 cc<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Kulit
dingin.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">Resti infeksi berhubungan
dengan tindakan infasif<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 108.0pt;" valign="top" width="144">
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt;">
<span lang="SV">Tujuan :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt;">
<span lang="SV">Klien melaporkan nyeri hilang <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt;">
<span lang="SV">kriteria hasil :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt; mso-list: l9 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Nyeri
hilang/ terkontrol<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt; mso-list: l9 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Kualitas
nyeri menujukkan sekalanyeri 0-3<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt; mso-list: l9 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Ekspresi
wajah tidak tidak meringis<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt; mso-list: l9 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Tidak
melakukan perlakuan distraksi dengan melakukan kegiatan yang berulang<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt; mso-list: l9 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Respon
otonomik :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt;">
<span lang="SV">Diaporosis (-)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt;">
<span lang="SV">Tekanan darah stabil 120/80 mmHg <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt;">
<span lang="SV">Pola nafas efektif 24x/menit dispneu<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.3pt;">
<span lang="SV">Klien dapat konsentrasi dan kooperatif<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="SV">Tujuan :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="SV">Dapat mempertahankan / mempernaiki perfusi jaringan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="SV">Kriteria hasil :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Mendemonstrasikan
perfusi yang adekuat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">TTV
stabil <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">TD
130/80 mmHg<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Nadi
80x/menit<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-list: l5 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Kulit
hangat <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">Tidak terjad perdarahan (
normal tidak lebih dari 500 cc)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">Setelah diberikan asuha
keperawatan selama 4 x 24 jam diharapkan klien dapat menerapkan tehnik
kontrol infeksi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt; text-align: justify;">
<span lang="SV">Kriteria Hasil :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.95pt; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Suhu
37º C<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.6pt; mso-list: l10 level1 lfo15; tab-stops: list 39.6pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Pola
nafas efektif 24x/menit<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 39.6pt; mso-list: l10 level1 lfo15; tab-stops: list 39.6pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Tidak
terdapat nyeri tekan luka bekas dari drainase dengan tanda awal penyembuhan
tidak terdapat kemerahan<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 128.7pt;" valign="top" width="172">
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt;">
<span lang="SV">Mandiri : <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; mso-list: l7 level2 lfo10; text-indent: -17.45pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">tentukan
sifat, lokasi dan durasi nyeri. Kaji kontraksi uterus, hemorogi,retoplasma,
atau nyeri tekan abdomen.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 25.8pt; mso-list: l7 level2 lfo10; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Kaji
stres psikologi klien/pasangan dan respon emosional terhadap kejadian <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Berkan
lingkungan yang tenang untuk menghilangkan rasa nyeri<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.6pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">olanorasi
:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">beri
narkotik / sedatif, berikan obat obat praoperatif bila prosedur pembedahan diindikasikan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">perhatikan
status fissologi ibu, status sirkulasi dan volume darah.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Auskultasi
dan laporkan DJJ catat bradikardi, takikardi, perubahan pada aktifitas janin <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">catat
kehilangan darah ibu dan adanya kontrasi uterus<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">anjurkan
tirah baring dalam posisi miring.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 24.2pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">infeksi
balutan abdominal terhadap eksudat atau rembesan lepaskan balutan sesuai
indikasi<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 24.2pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Dorongan
dan masukan cairan oral dan diet tinggi protein vit C dan besi<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 24.2pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Kaji
suhu, nadi dan jumlah sel darah putih<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 24.2pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Faal
lokasi dan kontraktifitas uterus, perhatikan perubahan adanya nyeri pad
uterus yang eksterna<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 24.2pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Berikan
infus antibiotik profilaksi dengan detil pertama biasanya segera setelah
pengekleman tali pusat dan dua dosis lagi masing-masing berjarak 6 jam<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 24.2pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Dapatkan
kultur darah dan urin bila infeksi dicurigai<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 24.2pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Berikan
antibiotik khusus untuk proses infeksi yang diidentifikasi <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.3pt;" valign="top" width="200">
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 72.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">membantu
dalam mendiagnosa dan memilih tindakan, ketidaknyamanan dihubungkan dengan
aborsi spontan, karena kontraksi uterus yang mungkin diperberat oleh
oksitosin’<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">ansietas
sebagai respon terhadap situasi darurat dapat memperberat ketidaknyamanan
klien<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Dapat
membantu dalam menurunkan tingkat ansietas dan karenanya mereduksi
ketidakinyamanan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: .9pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Meningkatkan
kenymanan, menurunkan resiko kompliksi pembedahan.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Kejadian
perdarahan potensialmerusak hasil kehamilan, kemungkinan menyebabkan
hipovolemia/ hipoksia uteroplasenta.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">mengkaji
berlanjutnya hipoksia janin. Pada awalnya janin berespon pada penurunan kadar
O2 dengan takikardi peningkatan gerakan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">bila
kontraksi uterus disertai dilatasi serviks, tirah baring dan medikasi mungkin
tidak efektif dalam mempertahankan kehamilan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.05pt; mso-list: l13 level2 lfo11; text-indent: -17.05pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">menghilangkan
tekanan pada VCI sdan meningktakan sirkulasi plasenta/ janin dalam pertukaran
O2<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.8pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Balutan
steril pada kelahiran membantu melindungi luka dari kontaminasi, rembesan
dapat mengganggu hematoma, gangguan penyatuan jaringan dehisens memerlukan
kelanjutan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.8pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Mencegah
dan memaksimalkan sirkulasi dan aliran protein dan vitamin diperlukan
pembentukan kol bezi diperlukan sintesis Hb<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.8pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Dalam
paska operasi ketiga leukositas takikardi menunjukkan infeksi, peningkatan
sampai 38º C dalam jam pertama<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.8pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Setelah
kelahiran fundus tetap ketinggian dalam selama sampai lima hari infolusi
mudah dengan peningkatan lokhea.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.8pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Menurunkan
kemungkinan endometritis paska sesuai komplikasi obses tromboflekbitis<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.8pt; mso-list: l13 level2 lfo11; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Bakterious
lebih pada klien mengalami pecah selama 6 jam dari pada klien ketubannya
tetap sebelum mesecio sesarea<o:p></o:p></span></div>
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<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: list 72.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: center;">
<span lang="SV">BAB III<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: center;">
<span lang="SV">PENUTUP<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="SV">KESIMPULAN<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36.0pt;">
<span lang="SV">Suatu kehamilan dikatakan abortus apabila
kehamilan tersebut terhenti atau gagal dipertahankan pada usia kehamilan kurang
dari 22 minggu atau berat badan janin kurang dari 500 gr. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36.0pt;">
<span lang="SV">Penyebab kelainan hasil konsepsi yaitu :
abnormalitas uteri, kerusakan pada serviks, penyakit-penyakit maternal dan
penggunaan obat, penyakit, trauma. Faktor hormonal, dan kelainan plasenta.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Faktor
ovofetal yang menyebabkan abortus adalah kelainan pertumbuhan janin dan
kelainan pada plasenta. Penyebab kelainan pertumbuhan janin ialah kelainan
kromosom, lingkungan kurang sempurna, dan pengaruh dari luar. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Kelainan
plasenta disebabkan endarteritis pada villi koriales yang menghambat
oksigenisasi plasenta sehingga terjadi gangguan pertumbuhan bahkan menyebabkan
kematian (Prawirohardjo, S, 2002).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">Keadaan
ibu yang menyebabkan abortus antara lain: <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">penyakit
Ibu seperti pneumonia, tifus abdominalis, pielonefritis, malaria, <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV"> toksin, bakteri, virus, plasmodium masuk ke janin menyebabkan
kematian sehingga terjadi abortus, <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">penyakit
menahun, dan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV"> kelainan traktus genitalis, seperti
inkompetensi serviks, retroversi uteri, mioma uteri, dan kelainan bawaan uterus
(Prawirohardjo, 2002).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="SV" style="font-family: Symbol; mso-ansi-language: SV; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="SV">faktor-faktor
hormonal, misalnya penurunan sekresi progesteron diperkirakan sebagai penyebab
terjadinya abortus pada usia kehamilan 10-12 minggu, yaitu pada saat plasenta
mengambil alih fungsi korpus luteum dalam produksi hormon.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<span lang="SV">DAFTAR PUSTAKA<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<span lang="SV">Cunningham. F. G. et all. </span>(2006). <i>Obstetri Williams</i>. <st1:place w:st="on"><st1:city w:st="on">Jakarta</st1:city></st1:place> : EGC</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<st1:city w:st="on"><st1:place w:st="on">Hamilton</st1:place></st1:city>. <span lang="SV">P.M. (1995). <i>Dasar-Dasar Keperawatan
Maternitas</i>. Jakarta : EGC<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; text-indent: -45.0pt;">
Liewell.YN. D. and Jones. <span lang="SV">(2002).
<i>Dasar-Dasar Obstetric dan Ginekologi</i>.
Jakarta : Penerbit Hipokrates<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; text-indent: -45.0pt;">
<span lang="SV">Sastrawinatan. S. (2002). Obstetri
Patologi. Bandung : FK UNPAD<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; text-indent: -45.0pt;">
<span lang="SV">Sibuea, Daulat perdarahan
selama kehamilan. Retrieved Maret 2009 from <a href="http://www.geocities.com/dien%20.dien.99/utama.html">http://Www.Geocities.Com/Dien
.Dien.99/Utama.Html</a>.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; text-indent: -45.0pt;">
<span lang="SV">Arian Saladin. Perdarahan pada
kehamilan muda. </span>Retrieved Maret 1, 2009 from <span lang="SV"><a href="http://www.zwani.com/"><span lang="EN-US">http://www.zwani.com</span></a></span>
</div>
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<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-39972461082877658782012-03-03T21:39:00.002-08:002012-03-03T21:39:15.896-08:00<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b><span style="line-height: 150%;">LAPORAN
PENDAHULUAN<o:p></o:p></span></b></div>
<h1 style="text-align: center;">
<span style="font-size: small;">ASKEP PADA KLIEN DENGAN CA NASOFARING</span></h1>
<h2 style="margin-left: 17.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -17.0pt;">
<!--[if !supportLists]--><span style="font-size: small;">A.<span style="font-weight: normal;"> </span><!--[endif]-->Pengertian</span></h2>
<div class="MsoBodyTextIndent">
Karsinoma nasofaring merupakan tumor ganas yang
tumbuh di daerah nasofaring dengan predileksi di fossa Rossenmuller dan atap
nasofaring. Karsinoma nasofaring
merupakan tumor ganas daerah kepala dan leher yang terbanyak ditemukan di
Indonesia. (Efiaty & Nurbaiti, 2001)</div>
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<br /></div>
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<!--[if !supportLists]--><b>B.<span style="font-weight: normal; line-height: normal;">
</span></b><!--[endif]--><b>Etiologi<o:p></o:p></b></div>
<div class="MsoBodyText" style="margin-left: 18.7pt; text-indent: 28.05pt;">
Insidens
karsinoma nasofaring yang tinggi ini dihubungkan dengan kebiasaan makan,
lingkungan dan virus Epstein-Barr (Sjamsuhidajat, 1997). Selain itu faktor geografis,
rasial, jenis kelamin, genetik, pekerjaan, kebiasaan hidup, kebudayaan, sosial
ekonomi, infeksi kuman atau parasit juga
sangat mempengaruhi kemungkinan timbulnya tumor ini. Tetapi sudah hampir dapat
dipastikan bahwa penyebab karsinoma nasofaring adalah virus Epstein-barr,
karena pada semua pasien nasofaring didapatkan titer anti-virus EEB yang cukup
tinggi (Efiaty & Nurbaiti, 2001).</div>
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<br /></div>
<h3>
<!--[if !supportLists]--><span style="font-size: small;">C.<span style="font-weight: normal;"> </span><!--[endif]-->Pathofisiologi
/ Pathways</span></h3>
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Terlampir</div>
<h3>
<!--[if !supportLists]--><span style="font-size: small;">D.<span style="font-weight: normal;"> </span><!--[endif]-->Tanda
dan Gejala</span></h3>
<div class="MsoBodyTextIndent2" style="text-align: justify;">
Gejala karsinoma
nasofaring dapat dikelompokkan menjadi 4 bagian, yaitu antara lain :</div>
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<!--[if !supportLists]-->1.<span style="line-height: normal;">
</span><!--[endif]-->Gejala nasofaring</div>
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Gejala nasofaring dapat berupa epistaksis ringan atau
sumbatan hidung.</div>
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<!--[if !supportLists]-->2.<span style="line-height: normal;">
</span><!--[endif]-->Gangguan pada telinga</div>
<div class="MsoBodyTextIndent3">
Merupakan gejala dini karena tempat asal tumor
dekat muara tuba Eustachius (fosa Rosenmuller). Gangguan yang timbul akibat
sumbatan pada tuba eustachius seperti tinitus, tuli, rasa tidak nyaman di
telinga sampai rasa nyeri di telinga (otalgia)</div>
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<!--[if !supportLists]-->3.<span style="line-height: normal;">
</span><!--[endif]-->Gangguan mata dan syaraf</div>
<div class="MsoBodyTextIndent3">
Karena dekat dengan rongga tengkorak maka terjadi
penjalaran melalui foramen laserum yang akan mengenai saraf otak ke III, IV, VI
sehingga dijumpai diplopia, juling, eksoftalmus dan saraf ke V berupa gangguan
motorik dan sensorik.</div>
<div class="MsoBodyTextIndent3">
Karsinoma yang lanjut akan mengenai saraf otak ke
IX, X, XI dan XII jika penjalaran melalui foramen jugulare yang sering disebut
sindrom Jackson. Jika seluruh saraf otak terkena disebut sindrom unialteral.</div>
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<!--[if !supportLists]-->4.<span style="line-height: normal;">
</span><!--[endif]-->Metastasis ke kelenjar leher</div>
<div class="MsoBodyTextIndent3">
Yaitu dalam bentuk benjolan medial terhadap
muskulus sternokleidomastoid yang akhirnya membentuk massa besar hingga kulit
mengkilat.</div>
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<br /></div>
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<!--[if !supportLists]--><b>E.<span style="font-weight: normal; line-height: normal;">
</span></b><!--[endif]--><b>Pemeriksaan Penunjang<o:p></o:p></b></div>
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<!--[if !supportLists]-->1.
<!--[endif]-->Pemeriksaan CT-Scan daerah kepala dan leher untuk
mengetahui keberadaan tumor sehingga tumor primer yang tersembunyi pun akan
ditemukan.</div>
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<!--[if !supportLists]-->2.<span style="line-height: normal;">
</span><!--[endif]-->Pemeriksaan Serologi IgA anti EA dan IgA anti VCA untuk
mengetahui infeksi virus E-B.</div>
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<!--[if !supportLists]-->3.<span style="line-height: normal;">
</span><!--[endif]-->Untuk diagnosis pasti ditegakkan dengan Biopsi
nasofaring dapat dilakukan dengan dua cara yaitu dari hidung dan mulut.
Dilakukan dengan anestesi topikal dengan Xylocain 10 %.</div>
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<!--[if !supportLists]-->4.<span style="line-height: normal;">
</span><!--[endif]-->Pengerokan dengan kuret daerah lateral nasofaring dalam
narkosis.</div>
<h3>
<!--[if !supportLists]--><span style="font-size: small;">F.<span style="font-weight: normal;"> </span><!--[endif]-->Penatalaksanaan
Medis</span></h3>
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<!--[if !supportLists]-->1.<span style="line-height: normal;">
</span><!--[endif]-->Radioterapi merupakan pengobatan utama</div>
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<!--[if !supportLists]-->2.<span style="line-height: normal;">
</span><!--[endif]-->Pengobatan tambahan yang diberikan dapat berupa diseksi
leher ( benjolan di leher yang tidak menghilang pada penyinaran atau timbul
kembali setelah penyinaran dan tumor induknya sudah hilang yang terlebih dulu
diperiksa dengan radiologik dan serologik) , pemberian tetrasiklin, faktor
transfer, interferon, kemoterapi, seroterapi, vaksin dan antivirus.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Pemberian ajuvan kemoterapi yaitu Cis-platinum, bleomycin dan
5-fluorouracil. Sedangkan kemoterapi praradiasi dengan epirubicin dan cis-platinum.
Kombinasi kemo-radioterapi dengan mitomycin C dan 5-fluorouracil oral sebelum
diberikan radiasi yang bersifat “RADIOSENSITIZER”.</div>
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<br /></div>
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<!--[if !supportLists]--><b>G.<span style="font-weight: normal; line-height: normal;">
</span></b><!--[endif]--><b>Pengkajian<o:p></o:p></b></div>
<h3 style="margin-left: 37.4pt; tab-stops: list 37.4pt; text-indent: -20.4pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-weight: normal;">1.
</span><!--[endif]--><span style="font-weight: normal;">Faktor
herediter atau riwayat kanker pada keluarga misal ibu atau nenek dengan riwayat
kanker payudara<o:p></o:p></span></span></h3>
<h3 style="margin-left: 37.4pt; tab-stops: list 37.4pt; text-indent: -20.4pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-weight: normal;">2.
</span><!--[endif]--><span style="font-weight: normal;">Lingkungan yang
berpengaruh seperti iritasi bahan kimia, asap sejenis kayu tertentu.<o:p></o:p></span></span></h3>
<h3 style="margin-left: 37.4pt; tab-stops: list 37.4pt; text-indent: -20.4pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-weight: normal;">3.
</span><!--[endif]--><span style="font-weight: normal;">Kebiasaan
memasak dengan bahan atau bumbu masak tertentu dan kebiasaan makan makanan yang
terlalu panas serta makanan yang diawetkan ( daging dan ikan).<o:p></o:p></span></span></h3>
<h3 style="margin-left: 37.4pt; tab-stops: list 37.4pt; text-indent: -20.4pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-weight: normal;">4.
</span><!--[endif]--><span style="font-weight: normal;">Golongan sosial
ekonomi yang rendah juga akan menyangkut keadaan lingkungan dan kebiasaan
hidup.<o:p></o:p></span></span></h3>
<h3 style="margin-left: 37.4pt; tab-stops: list 37.4pt; text-indent: -20.4pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-weight: normal;">5.
</span><!--[endif]--><span style="font-weight: normal;">Tanda dan
gejala :<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Aktivitas<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: none; tab-stops: 36.0pt; text-indent: 0cm;">
<span style="font-weight: normal;"><span style="font-size: small;">Kelemahan atau keletihan. Perubahan pada pola
istirahat; adanya faktor-faktor yangmempengaruhi tidur seperti nyeri, ansietas.<o:p></o:p></span></span></h3>
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<br /></div>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Sirkulasi<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: none; tab-stops: 36.0pt; text-indent: 0cm;">
<span style="font-weight: normal;"><span style="font-size: small;">Akibat metastase tumor terdapat palpitasi, nyeri
dada, penurunan tekanan darah, epistaksis/perdarahan hidung.<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Integritas ego<o:p></o:p></span></span></h3>
<h3 style="margin-left: 56.1pt; mso-list: none; tab-stops: 36.0pt; text-indent: 0cm;">
<span style="font-weight: normal;"><span style="font-size: small;">Faktor stres, masalah tentang perubahan penampilan,
menyangkal diagnosis, perasaan tidak berdaya, kehilangan kontrol, depresi,
menarik diri, marah.<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Eliminasi<o:p></o:p></span></span></h3>
<h3 style="margin-left: 56.1pt; mso-list: none; tab-stops: 36.0pt; text-indent: 0cm;">
<span style="font-weight: normal;"><span style="font-size: small;">Perubahan pola defekasi konstipasi atau diare,
perubahan eliminasi urin, perubahan bising usus, distensi abdomen.<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Makanan/cairan<o:p></o:p></span></span></h3>
<h3 style="margin-left: 56.1pt; mso-list: none; tab-stops: 36.0pt; text-indent: 0cm;">
<span style="font-weight: normal;"><span style="font-size: small;">Kebiasaan diit buruk ( rendah serat, aditif,
bahanpengawet), anoreksia, mual/muntah, mulut rasa kering, intoleransi makanan,perubahan
berat badan, kakeksia, perubahan kelembaban/turgor kulit.<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Neurosensori<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: none; tab-stops: 36.0pt; text-indent: 0cm;">
<span style="font-weight: normal;"><span style="font-size: small;">Sakit kepala, tinitus, tuli, diplopia, juling,
eksoftalmus<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Nyeri/kenyamanan<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: none; tab-stops: 36.0pt; text-indent: 0cm;">
<span style="font-weight: normal;"><span style="font-size: small;">Rasa tidak nyaman di telinga sampai rasa nyeri
telinga (otalgia), rasa kaku di daerah leher karena fibrosis jaringan akibat
penyinaran<o:p></o:p></span></span></h3>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Pernapasan<o:p></o:p></span></span></h3>
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Merokok
(tembakau, mariyuana, hidup dengan seseorang yang merokok), pemajanan</div>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Keamanan<o:p></o:p></span></span></h3>
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Pemajanan pada
kimia toksik, karsinogen, pemajanan matahari lama / berlebihan, demam, ruam
kulit.</div>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Seksualitas<o:p></o:p></span></span></h3>
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Masalah seksual
misalnya dampak hubungan, perubahan pada tingkat kepuasan.</div>
<h3 style="margin-left: 54.45pt; mso-list: l3 level1 lfo3; tab-stops: list 55.4pt; text-indent: -17.05pt;">
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-weight: normal;">Interaksi
sosial<o:p></o:p></span></span></h3>
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Ketidakadekuatan/kelemahan sistem pendukung</div>
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<br /></div>
<h4 style="margin-left: 0cm; text-align: center;">
<span style="font-family: "Arial","sans-serif";">DAFTAR
PUSTAKA<o:p></o:p></span></h4>
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<br /></div>
<h3>
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: "Arial","sans-serif"; font-weight: normal; mso-fareast-font-family: Arial;">1.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-weight: normal;">Doenges, Marilynn E. Rencana Asuhan Keperawatan : Pedoman
untuk Perencanaan dan pendokumentasian Perawatan Pasien. Alih bahasa I Made
Kariasa. Ed. 3. Jakarta : EGC;1999<o:p></o:p></span></span></h3>
<h3>
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: "Arial","sans-serif"; font-weight: normal; mso-fareast-font-family: Arial;">2.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-weight: normal;">Efiaty Arsyad Soepardi & Nurbaiti Iskandar. <i>Buku
Ajar Ilmu Kesehatan : Telinga Hidung Tenggorok Kepala Leher.</i> Jakarta :
Balai Penerbit FKUI; 2001<o:p></o:p></span></span></h3>
<h3>
<!--[if !supportLists]--><span style="font-size: small;"><span style="font-family: "Arial","sans-serif"; font-weight: normal; mso-fareast-font-family: Arial;">3.<span style="font-family: 'Times New Roman';">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-weight: normal;">R. Sjamsuhidajat &Wim de jong. <i>Buku Ajar Ilmu Bedah</i>.
Edisi revisi. Jakarta : EGC ; 1997<o:p></o:p></span></span></h3>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; text-indent: -18.7pt;">
4. <span style="font-family: "Arial","sans-serif";">Smeltzer
Suzanne C. <i>Buku Ajar Keperawatan Medikal Bedah Brunner & Suddarth</i>.
Alih bahasa Agung Waluyo, dkk. Editor Monica Ester, dkk. Ed. 8. Jakarta : EGC;
2001</span></div>
<br />Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-4943509664292219862011-11-26T06:05:00.001-08:002011-11-26T06:06:56.882-08:00Bronkopneumonia<!--[if !mso]>
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<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">KONSEP TEORI </span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">BRONKOPNEUMONIA</span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Definisi</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Pneumonia
merupakan peradangan perenkim paru-paru yang biasanya berasal dari suatu
infeksi.(Price,1995)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Pneumonia adalah
peradangan yang mengenai parenkim paru, distal dari bronkiolus terminalis yang
mencakup bronkiolus respiratorius, alveoli, serta menimbulkan konsolidasi
jaringan paru dan menimbulkan gangguan pertukaran gas setempat (Zul, 2001)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Bronkopneumonia
digunakan untuk menggambarkan pneumonia yang mempunyai pola penyebaran berbercak,
teratur dalam satu atau lebih area terlokalisasi dalam bronki dan meluas ke
parenkim paru yang berdekatan di sekitarnya. Pada bronkopneumonia terjadi
konsolidasi area berbercak. (Smeltzer,2001).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="mso-ansi-language: EN-US;">Perubahan system respirasi yang berhubungan
dengan usia yang mempengaruhi kapasitas dan fungsi paru meliputi:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l14 level1 lfo17; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Peningkatan diameter anteroposterior dada.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l14 level1 lfo17; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Kolaps osteoporotik vertebrae yang
mengakibatkan kifosis (peningkatan kurvatura konveks tulang belakang).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l14 level1 lfo17; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Kalsifikasi kartilago kosta dan penurunan
mobilitas kosta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l14 level1 lfo17; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Penurunan efisiensi otot pernapasan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l14 level1 lfo17; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Peningkatan rigiditas paru.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l14 level1 lfo17; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Penurunan luas permukaan alveoli.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Klasifikasi pneumonia</span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>Klasifikasi menurut Zul Dahlan (2001):</span></div>
<ol start="1" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l0 level1 lfo3; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Berdasarkan
ciri radiologis dan gejala klinis, dibagi atas:</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pneumonia
tipikal, bercirikan tanda-tanda pneumonia lobaris dengan opasitas lobus atau
lobularis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pneumonia
atipikal, ditandai gangguan respirasi yang meningkat lambat dengan gambaran
infiltrate paru bilateral yang difus.</span></div>
<ol start="2" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l0 level1 lfo3; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Berdasarkan
faktor lingkungan</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pneumonia
komunitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">pneumonia
nosokomial</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">pneumonia
rekurens</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">pneumonia
aspirasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">pneumonia
pada gangguan imun</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">pneumonia
hipostatik.</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 36.0pt; text-align: justify;">
<br /></div>
<ol start="3" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l0 level1 lfo3; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Berdasarkan
sindrom klinis</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pneumonia
bakterial berupa: pneumonia bakterial tipe tipikal yang terutama mengenai
parenkim paru dalam bentuk bronkopneumonia dan pneumonia lobar serta pneumonia
bakterial tipe campuran atipikal yaitu perjalanan penyakit ringan dan jarang
disertai konsolidasi paru.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level2 lfo3; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pneumonia
non bakterial, dikenal pneumonia atipikal yang disebabkan mycoplasma, clamydia
pneumoniae atau legionella.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: list 36.0pt 108.0pt left 156.75pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 2;"> </span></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Klasifikasi berdasarkan Reeves
(2001):</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level1 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Community
Acquired Pneumonia dimulai sebagai penyakit pernafasan umum dan bisa berkembang
menjadi pneumonia. Pneumonia streptococcal merupakan organisme penyebab umum.
Tipe pneumonia ini biasanya menimpa kalangan anak-anak atau kalangan orang tua.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level1 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Hospital
Acquired pneumonia dikenal sebagai pneumonia nosokomial. Organisme seperti ini
aeruginisa pseudomonas. Klebsiella atau aureus stapilococcus, merupakan bakteri
umum penyebab Hospital Acquired pneumonia </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level1 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Lobar dan
bronkopneumonia dikategorikan berdasarkan lokasi anatomi infeksi. Sekarang ini
pneumonia diklasifikasikan menurut organisme, bukan hanya menurut lokasi
anatominya saja.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level1 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pneumonia
viral, bakterial dan fungi dikategorikan berdasarkan pada agen penyebabnya,
kultur sensifitas dilakukan untuk mengidentifikasikan organisme perusak.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; tab-stops: list 72.0pt; text-align: justify; text-indent: -36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Etiologi</span></b></div>
<ol start="1" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l18 level1 lfo5; tab-stops: 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Bakteri</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 1;"> </span>Pneumonia bakteri biasanya didapatkan pada
usia lanjut. Organsime gram positif seperti: streptococcus pneumonia, s. aureus
dan s. pyogenesis. Bakteri gram negative seperti Haemophilus influenza,
klebsiella pneumonia dan P.Aeruginosa.</span></div>
<ol start="2" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l18 level1 lfo5; tab-stops: 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Virus</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 1;"> </span>Disebabkan oleh virus influenza yang
menyebar melalui transmisi droplet. Cytomegalovirus dalam hal ini dikenal
sebagai penyabab utama pneumonia virus.</span></div>
<ol start="3" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l18 level1 lfo5; tab-stops: 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Jamur</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 1;"> </span>Infeksi yang disebabkan jamur seperti
histoplasmosis menyebar melalui penghirupan udara yang mengandung spora dan
biasanya ditemukan pada kotoran burung, tanah serta kompos</span></div>
<ol start="4" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l18 level1 lfo5; tab-stops: 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Protozoa</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 1;"> </span>Menimbulkan terjadinya pneumocystis
carinii pneumonia (CPC). Biasanya menjangkiti pasien yang mengalami
imunosupresi. (Reeves,2001).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Pathways</span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">
</span>TERLAMPIR</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Manifestasi klinis</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level2 lfo1; tab-stops: list 45.0pt; text-align: justify; text-indent: -54.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Kesulitan
dan sakit pada saat pernapasan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: list 45.0pt; text-align: justify; text-indent: -54.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 2;"> </span>Nyeri
pleuritik, nafas dangkal dan mendengkur, takipnea.</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Bunyi
nafas di atas area yang mengalami konsolidasi.</span></div>
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<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 2;"> </span>Mengecil,
kemudian menjadi hilang, krekels, ronki, egofoni.</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Gerakan
dada tidak simetris</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Menggigil
dan demam 38,8<sup>0 </sup>C sampai 41,1<sup>o </sup>C, delirium</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Diaforesis</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Anoreksia</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Malaise</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Batuk
kental, produktif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; tab-stops: list 45.0pt; text-align: justify; text-indent: -54.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 1;"> </span>Sputum kuning
kehijauan kemudian berubah menjadi kemerahan atau berkarat.</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Gelisah</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level2 lfo1; tab-stops: list 45.0pt; text-align: justify; text-indent: -54.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Sianosis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: list 45.0pt; text-align: justify; text-indent: -54.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-tab-count: 2;"> </span>Area
sirkumoral, dasar kuku kebiruan.</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Masalah-masalah
psikososial: disorientasi, ansietas, takut mati.</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 45.0pt; text-align: justify; text-indent: -54.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">F.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Pemeriksaan penunjang</span></b></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Sinar X:
mengidentifikasi distribusi struktural; dapat juga menyatakan abses
luas/infilrat, empiema (stapilococcus);infiltrate menyebar atau terlokalisasi
(bacterial);atau penyebaran/perluasan infiltrate nodul (virus). Pneumonia
mikoplasma sinar X dada mungkin bersih.</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">GDA: tidak
normal mungkin terjadi, tergantung pada luas paru yang terlibat dan penyakit
paru yang ada.</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pemeriksaan
gram/kultur sputum dan darah: diambil dengan biopsi jarum, aspirasi
transtrakeal, bronkoskopi fiberotik atau biopsy pembukaan paru untuk mengatasi
organisme penyebab.</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">JDL:
leukositosis biasanya ada, meski sel darah putih rendah terjadi pada infekksi
virus, kondisi tekanan imun memungkinkan berkembangnya pneumonia bakterial. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level2 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pemeriksan
serologi; titer virus atau legionella, aglutinin dingin.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level2 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">LED:
meningkat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level2 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pemeriksaan
fungsi paru: volume mungkin menurun (kongesti dan kolaps); tekanan jalan napas
mungkin meningkat dan komplain menurun, hipoksemia.elektrolit natrium dan
klorida mungkin rendah.</span></div>
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<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Bilirubin
mungkin meningkat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level2 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Aspirasi
perkutan/biopsi jaringan paru terbuka menyatakan intranuklear tipikal dan
keterlibatan sitoplasmik (CMV) (Doenges, 1999).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: list 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">G.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Penatalaksanaan</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.4pt; mso-list: l9 level1 lfo6; tab-stops: list 46.4pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Kemoterapi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Pemberian kemoterapi harus
berdasarkan petunjuk penemuan kuman penyebab infeksi (hasik kultur sputum dan
tes sensitivitas kuman teradap antibodi). Bila penyakitnya ringan antibiotik
diberikan secara oral, sedangkan bila berat diberikan secara parenteral.
Apabila terdapat penurunan fungsi ginjal akibat proses penuaan, maka harus
diingat kemungkinan penggunaan antibiotik tertentu perlu penyesuaian dosis
(Harasawa,1989)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.4pt; mso-list: l9 level1 lfo6; tab-stops: list 46.4pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Pengobatan umum</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level2 lfo6; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Terapi
oksigen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level2 lfo6; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Hidrasi,
bila ringan hidrasi oral, tetapi jika berat dehidrasi dilakukan secara
parenteral.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level2 lfo6; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Fisioterapi,
penderita perlu tirah baring dan posisi penderita perlu diubah-ubah untuk
menghindari pneumonia hipografik, kelemahan dan dekubitus.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l6 level1 lfo1; tab-stops: list 9.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">H.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Pengkajian</span></b></div>
<ol start="1" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Aktivitas/istirahat</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Kelemahan, kelelahan, insomnia.
Letargi, penurunan toleransi terhadap aktivitas.</span></div>
<ol start="2" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Sirkulasi</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Riwayat gagal jantung kronis,
takikardia, penampilan terlihat pucat.</span></div>
<ol start="3" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Integritas
ego</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Banyak stressor, masalah finansial.</span></div>
<ol start="4" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Makanan/cairan</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Kehilangan nafsu makan,
mual/muntah, riwayat DM. Distensi abdomen, hiperaktif bunyi usus, kulit kering
dengan turgor buruk, penampilan malnutrisi.</span></div>
<ol start="5" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Neurosensori</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Sakit kepala, perubahan mental.</span></div>
<ol start="6" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Nyeri/kenyamanan</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Sakit kepala , nyeri dada meningkat
dan batuk myalgia.</span></div>
<ol start="7" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Pernafasan</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Riwayat PPOM, merokok sigaret,
takipnea, dispnea, pernafasan dangkal, penggunaan otot aksesori, pelebaran
nasal. Sputum berwana merah muda, berkarat atau purulen. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Perkusi: pekak di atas area yang
konsolidasi, gesekan friksi pleural. Bunyi nafas: menurun atau tidak ada di
atas area yang terlibat atau nafas bronchial. Fremitus: taktil dan vocal
meningkat dengan konsolidasi.. Warna: pucat, atau sianosis pada bibir/kuku.</span></div>
<ol start="8" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Keamanan</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Riwayat gangguan sistem imun,
demam. Berkeringat, menggigil berulang, gemetar, kemerahan mungkin pada kasus
rubella/varisela.</span></div>
<ol start="9" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo7; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Penyuluhan</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span style="mso-ansi-language: EN-US;">Riwayat mengalami pembedahan,
penggunaan alkohol kronis.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Diagnosa keperawatan</span></b></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo8; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Bersihan
jalan nafas tidak efektif berhubungan dengan inflamasi trakeobronkial,
pembentukan oedema, peningkatanan produksi sputum, nyeri pleuritik,
penurunan energi, kelemahan.ditandai dengan perubahan frekuensi kedalaman
pernafasan, bunyi nafas tidak normal, penggunaan otot aksesori, dispnea,
sianosis, batuk efektif/tidak efektif dengan atau tanpa produksi sputum.</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l17 level1 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kriteria hasil</span></b><span style="mso-ansi-language: EN-US;">: menunjukkan perilaku mencapai kebersihan
jalan nafas, menunjukkan jalan nafas paten dengan bunyi nafas bersih, tidak ada
dispnea atau sianosis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l5 level1 lfo10; tab-stops: list 36.0pt left 54.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Intervensi keperawatan:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level3 lfo10; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Kaji frekuensi/ kedalaman pernafasan dan
gerakan dada.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level3 lfo10; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Auskultasi paru, catat area penurunan/tidak ada
aliran udara dan bunyi nafas tambahan (krakles, mengi)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level3 lfo10; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Bantu pasien untuk batuk efektif dan nafas
dalam</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level3 lfo10; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Berikan cairan sedikitnya 2500ml/hari.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level3 lfo10; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Kolaborasi: </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; mso-list: l5 level4 lfo10; tab-stops: list 81.0pt; text-align: justify; text-indent: -72.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Bantu mengawasi efek pengobatan nebulizer dan
fisioterapi lain.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; mso-list: l5 level4 lfo10; tab-stops: list 81.0pt; text-align: justify; text-indent: -9.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Berikan obat sesuai indikasi: mukolitik,
ekspektoran, bronkodilator, analgesik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; mso-list: l5 level4 lfo10; tab-stops: list 81.0pt; text-align: justify; text-indent: -72.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Berikan cairan tambahan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; mso-list: l5 level4 lfo10; tab-stops: list 81.0pt; text-align: justify; text-indent: -72.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Awasi seri sinar X dada, GDA, Nadi oksimetri.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; mso-list: l5 level4 lfo10; tab-stops: list 81.0pt; text-align: justify; text-indent: -72.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Bantu bronkoskopi/torakosintesis bila
diidikasikan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<br /></div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo8; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Kerusakan
pertukaran gas berhubungan dengan perubahan membran alveolar-kapiler (efek
inflamasi) dan gangguan kapasitas oksigen darah ditandai dengan dispnea,
sianosis, taikardia, gelisah,/perubahan mental, hipoksia.</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kriteria hasil:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Menunjukkan perbaikan ventilasi dan
oksigenasi jaringan dengan GDA dalam rentang normal dan tidak ada gejala distress
pernapasan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Berpastisipasi pada tindakan untuk
memaksimalkan oksigen.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Intervensi keperawatan:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Mandiri:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Kaji
frekuensi, kedalaman dan kemudahan bernafas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Observasi
warna kulit, membran mukosa dan kuku.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Kaji
status mental.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Awasi
status jantung/irama</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Awasi suhu
tubuh, sesuai indikasi. Bantu tindakan kenyamanan untuk menurunkan demam dan
menggigil.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pertahankan
istirahat tidur.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Tinggikan
kepala dan dorong sering mengubah posisi, nafas dalam dan batuk efektif.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Kaji
tingkat ansietas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo11; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Dorong
menyatakan masalah/perasaan.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kolaborasi</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l8 level1 lfo12; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Berikan
terapi oksigen dengan benar.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l8 level1 lfo12; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Awasi GDA</span></div>
<ol start="3" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo8; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Pola nafas
tidak efektif berhubungan dengan proses inflamasi, penurunan kompliance
paru, nyeri ditandai dengan dispnea, takipnea, penggunaan otot aksesori,
perubahan kedalaman nafas, GDA abnormal.</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kriteria hasil</span></b><span style="mso-ansi-language: EN-US;">:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">Menunjukkan pola pernafasan
normal/efektif dengan GDA dalam rentang normal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Intervensi keperawatan</span></b><span style="mso-ansi-language: EN-US;">:</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Mandiri:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo13; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Kaji
frekuensi, kedalaman pernafasan dan ekspansi dada.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo13; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Auskultasi
bunyi nafas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo13; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Tinggikan
kepala dan bahu.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo13; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Obsrvasi
pola batuk dan karakter sekret.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo13; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Dorong/bantu
pasien dalam nafas dalam dan latihan batuk efektif.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kolaborasi </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l13 level1 lfo14; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Berikan
oksigen tambahan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l13 level1 lfo14; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Awasi DGA.</span></div>
<ol start="4" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo8; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Peningkatan
suhu tubuh berhubungan dengan adanya proses infeksi.</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kriteria hasil:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="mso-ansi-language: EN-US;">pasien tidak memperlihatkan tanda peningkatan
suhu tubuh, tidak menggigil, nadi normal.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Intervensi keperawatan</span></b><span style="mso-ansi-language: EN-US;">:</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Mandiri:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo15; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Obsevasi
suhu tubuh (4 jam).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo15; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Pantau
warna kulit.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo15; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Lakukan
tindakan pendinginan sesuai kebutuhan.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kolaborasi:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l11 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Berikan
obat sesuai indikasi:antiseptik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l11 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Awasi
kultur darah dan kultur sputum, pantau hasilnya setiap hari.</span></div>
<ol start="5" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo8; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Resiko tinggi
penyebaran infeksi berhubungan dengan ketidakadekuatan pertahanan utama
dan tidak adekuat pertahanan sekunder (adanya infeksi, penekanan imun).</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level2 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kriteria hasil:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.85pt; mso-list: l7 level3 lfo8; tab-stops: 2.0cm; text-align: justify; text-indent: 17.6pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Mencapai
waktu perbaikan infeksi berulang tanpa komplikasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l7 level3 lfo8; text-align: justify; text-indent: -21.25pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Mengidentifikasi
intervensi untuk mencegah/ menurunkan resiko infeksi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; mso-list: l7 level4 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -108.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Intervensi keperawatan</span></b><span style="mso-ansi-language: EN-US;">:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level5 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Pantau TTV.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level5 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Anjurkan klien memperhatikan pengeluaran sekret
dan melaporkan perubahan warna jumlah dan bau sekret.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level5 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Dorong teknik mencuci tangan dengan baik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level5 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Ubah posisi dengan sering.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level5 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Batasi pengunjung sesuai indikasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level5 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Lakukan isolasi pencegahan sesuai indikasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level5 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Dorong keseimbangan istirahat adekuat dengan
aktivitas sedang.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level5 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Kolaborasi: Berikan antimikrobal sesuai
indikasi.</span></div>
<ol start="6" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo8; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Nyeri
berhubungan dengan inflamasi parenkim paru, reaksi seluler terhadap
sirkulasi toksin, batuk menetap ditandai dengan nyeri dada, sakit
kepala,nyeri sendi, melindungi area yang sakit, perilaku distraksi,
gelisah.</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l7 level6 lfo8; tab-stops: 54.0pt; text-align: justify; text-indent: -72.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kriteria hasil</span></b><span style="mso-ansi-language: EN-US;">:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level7 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Menyebabkan nyeri hilang/terkontrol.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level7 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Menunjukkan rileks, isirahat/tidur dan
peningkatan aktivitas dengan cepat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 288.0pt; mso-list: l7 level8 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -252.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Intervensi keperawatan:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo18; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Tentukan karakteristik nyeri.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo18; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Pantau TTV.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo18; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Ajarkan teknik relaksasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo18; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Anjurkan dan bantu pasien dalam teknik menekan
dada selama episode batuk.</span></div>
<ol start="7" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo8; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Resiko tinggi
nutrisi kurang dari kebutuhan tubuh berhubungan dengan peningkatan
kebutuhan metabolik sekunder terhadap demam dan proses infeksi, anoreksia,
distensi abdomen.</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level2 lfo18; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kriteria hasil:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 117.0pt; mso-list: l12 level3 lfo18; text-align: justify; text-indent: -63.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Menunjukkan
peningkatan nafsu makan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 117.0pt; mso-list: l12 level3 lfo18; text-align: justify; text-indent: -63.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Berat
badan stabil atau meningkat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; mso-list: l12 level4 lfo18; text-align: justify; text-indent: -108.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Intervensi keperawatan:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo19; tab-stops: list 36.0pt; text-align: justify; text-indent: 18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Identifikasi faktor yang menimbulkan mual atau
muntah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo19; tab-stops: list 36.0pt; text-align: justify; text-indent: 18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Berikan wadah tertutup untuk sputum dan buang
sesering mungkin.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo19; tab-stops: list 36.0pt; text-align: justify; text-indent: 18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Auskultasi bunyi usus.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo19; tab-stops: list 36.0pt; text-align: justify; text-indent: 18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Berikan makan porsi kecil dan sering.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo19; tab-stops: list 36.0pt; text-align: justify; text-indent: 18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Evaluasi status nutrisi.</span></div>
<ol start="8" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo8; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Kurang
pengetahuan mengenai kondisi dan kebutuhan tindakan berhubungan dengan
kurang terpajan informasi, kurang mengingat, kesalahan intrpretasi
ditandai dengan permintaan informasi, penyataan kesalahan konsep,
kesalahan mengulang.</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level2 lfo19; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Kriteria hasil:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 117.0pt; mso-list: l3 level3 lfo19; text-align: justify; text-indent: -63.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Menyatakan
pemahaman kondisi proses penyakit dan pengobatan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 117.0pt; mso-list: l3 level3 lfo19; text-align: justify; text-indent: -63.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-ansi-language: EN-US;">Melakukan
perubahan pola hidup.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; mso-list: l3 level4 lfo19; text-align: justify; text-indent: -108.0pt;">
<span style="font-family: Symbol; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Intervensi keperawatan:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Kaji fungsi normal paru.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Diskusikan aspek ketidakmampuan dari penyakit,
lamanya penyembuhan dan harapan kesembuhan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Berikan dalam bentuk tertulis dan verbal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Tekankan pentingnya melanjutkan batuk efektif.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level5 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-ansi-language: EN-US;">Tekankan perlunya melanjutrkan terapi
antibiotik selama periode yang dianjurkan.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="height: 54px; left: -25px; margin-left: 407px; margin-top: 23px; position: absolute; top: 7310px; width: 162px; z-index: 251657216;"></span></div>
<table cellpadding="0" cellspacing="0"><tbody>
<tr><td bgcolor="white" height="54" style="background: white; border: .75pt solid black; vertical-align: top;" width="162"><br /></td></tr>
</tbody></table>
<br />
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;"><span style="mso-list: Ignore;">J.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: EN-US;">Daftar pustaka</span></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: 150%; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Doenges,
Marylyn (2001). <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Rencana Asuhan Keperawatan</i></b>,
edisi 3, Jakarta:
EGC.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Hudak,Carolyn
M (1997). <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Keperawatan Kritis :Pendekatan Holistik</i></b>. Alih bahasa:
Allenidekania dkk. Jakarta.EGC.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Lackman’s
(1996). <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Care Principle and Practice of Medical Surgical Nursing</i></b>.
Philadelpia:WB Saunders Company.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Pasiyan
rahmatullah (1999).<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Geriatrik: Ilmu Kesehatan Usia Lanjut</i></b>.
editor:R.boedhi Darmoso dan Hadi Martono,Jakarta, Balai Penerbit FKUI.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Price sylvia Anderson (1994). <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Patofisiologi:
Konsep Klinis Proses-Proses Penyakit</i></b>. Alih bahasa: Peter anugerah.
Jakarta.
EGC.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Reevers,
Charlene J, et all (2000). <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Keperawatan Medikal Bedah</i></b>.
Jakarta: Salemba medica.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Smeltzer</span><span style="mso-ansi-language: EN-US;"> SC</span><span style="mso-ansi-language: EN-US;">, Bare B.G (2000). <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Buku Ajar Keperawatan
Medikal Bedah</i></b>. Volume 1. Jakarta:EGC.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="mso-ansi-language: EN-US;">Suyono,(2001).
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Ilmu
Penyakit Dalam</i></b>. Jilid II Edisi III. Jakarta: balai penerbit FKUI.</span></li>
</ul>
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<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-56031740959037136792011-11-15T06:38:00.001-08:002011-11-15T06:43:01.743-08:00Decompensasi Cordis<br />
<div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">LAPORAN PENDAHULUAN</span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DECOMPENSASI CORDIS</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">A.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGERTIAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Decompensasi
cordis adalah kegagalan jantung dalam upaya untuk mempertahankan peredaran
darah sesuai dengan kebutuhan tubuh.(Dr. Ahmad ramali.1994)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dekompensasi
kordis adalah suatu keadaan dimana terjadi penurunan kemampuan fungsi
kontraktilitas yang berakibat pada penurunan fungsi pompa jantung ( Tabrani,
1998; Price ,1995).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">B.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ETIOLOGI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mekanisme fisiologis yang
menyebabkan timbulnya dekompensasi kordis adalah keadaan-keadaan yang
meningkatkan beban awal, beban akhir atau yang menurunkan kontraktilitas
miokardium. Keadaan yang meningkatkan beban awal seperti regurgitasi aorta, dan
cacat septum ventrikel. Beban akhir meningkat pada keadaan dimana terjadi
stenosis aorta atau hipertensi sistemik. Kontraktilitas miokardium dapat
menurun pada infark miokard atau kardiomyopati. Faktor lain yang dapat
menyebabkan jantung gagal sebagai pompa adalah gangguan pengisisan ventrikel (
stenosis katup atrioventrikuler ), gangguan pada pengisian dan ejeksi ventrikel
(perikarditis konstriktif dan temponade jantung). Dari seluruh penyebab
tersebut diduga yang paling mungkin terjadi adalah pada setiap kondisi tersebut
mengakibatkan pada gangguan penghantaran kalsium di dalam sarkomer, atau di
dalam sistesis atau fungsi protein kontraktil ( Price. Sylvia A, 1995).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebab kegagalan jantung dikategori kepada tiga penyebab :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l17 level1 lfo7; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stroke volume : isi sekuncup</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l17 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kontraksi kardiak</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l17 level1 lfo7; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Preload dan afterload</span></li>
</ul>
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<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
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<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meliputi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-list: l7 level1 lfo8; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan
langsung pada jantung (berkurang kemampuan berkontraksi), infark myocarditis,
myocarial fibrosis, aneurysma ventricular</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-list: l7 level1 lfo8; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ventricular
overload terlalu banyak pengisian dari ventricle</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 74.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo9; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Overload
tekanan (kebanyakan pengisian akhir : stenosis aorta atau arteri pulmonal,
hipertensi pulmonari</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.7pt; mso-list: l1 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keterbatasan
pengisian sistolik ventricular</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.7pt; mso-list: l1 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pericarditis
konstriktif atau cardomyopati, atau aritmi, kecepatan yang tinggi,tamponade,
mitra; stenosis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.7pt; mso-list: l1 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ventrucular
overload (kebanyakan preload) regurgitasi dari aourta, defek seftum ventricalar</span></div>
<div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 18.0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Decompensai cordis terbagi atas dua
macam meliputi :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo10; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Decompensasi
cordis kiri/gagal jantung kiri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dengan
berkurangnya curah jantung pada gagal jantung mengakibatkan pada akhir sistol
terdapat sisa darah yang lebih banyak dari keadaan keadaan normal sehingga pada
masa diatol berikutnya akan bertambah lagi mengakibatkan tekanan distol semakin
tinggi, makin lama terjadi bendungan didaerah natrium kiri berakibat tejadi
peningkatan tekanan dari batas normal pada atrium kiri (normal 10-12 mmHg) dan
diikuti pula peninggian tekanan vena pembuluh pulmonalis dan pebuluh darah
kapiler di paru, karena ventrikel kanan masih sehat memompa darah terus dalam
atrium dalam jumlah yang sesuai dalam waktu cepat tekanan hodrostatik dalam
kapiler paru-paru akan menjadi tinggi sehingga melampui 18 mmHg dan terjadi
transudasi cairan dari pembuluh kapiler paru-paru..</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada saat
peningkatan tekanan arteri pulmonalis dan arteri bronkhialis, terjadi
transudasi cairanin tertisiel bronkus mengakibatkan edema aliran udara menjadi
terganggu biasanya ditemukan adanya bunyi eksspirasi dan menjadi lebih panjang
yang lebih dikenal asma kardial fase permulaan pada gagal jantung, bila tekanan
di kapiler makin meninggi cairan transudasi makin bertambah akan keluar dari
saluran limfatik karena ketidaka mampuan limfatik untuk, menampungnya (>25
mmHg) sehingga akan tertahan dijaringan intertissiel paru-paru yang makain lama
akan menggangu alveoli sebagai tempat pertukaran udara mengakibatkan udema paru
disertai sesak dan makin lama menjadi syok yang lebih dikenal dengan syak
cardiogenik diatandai dengan tekanan diatol menjadi lemah dan rendah serta
perfusi menjadi sangat kurang berakibat terdi asidosis otot-otot jantung yang
berakibat kematian.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gagalnya
kkhususnya pada ventrikel kiri untuk memompakan darah yang mengandung oksigen
tubuh yang berakibat dua antara lain:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda-tanda
dan gejela penurunan cardiak output seperit dyspnoe de effort (sesak nafas pada
akktivitas fisik, ortopnoe (sesak nafas pada saat berbaring dan dapat dikurangi
pada saat duduk atau berdiri.kemudian dispnue noktural paroksimalis (sesak
nafas pada malam hari atau sesak pada saat terbangun)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l13 level1 lfo11; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dan
kongesti paru seperti menurunnya tonus simpatis, darah balik yang bertambah,
penurunan pada pusat pernafasan, edema paru, takikakrdia,</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Disfungsi
diatolik, dimana ketidakmampuan relaksasi distolik dini ( proses aktif yang
tergantung pada energi ) dan kekakuan dindiing ventrikel</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo10; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Decompensasi
cordis kanan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kegagalan
venrikel kanan akibat bilik ini tidak mampu memeompa melawan tekanan yang naik
pada sirkulasi pada paru-paru, berakibat membaliknya kembali kedalam sirkulasi
sistemik, peningkatan volume vena dan tekanan mendorong cairan keintertisiel
masuk kedalam(edema perier) (long, 1996). Kegagalan ini akibat jantung kanan
tidak dapat khususnya ventrikel kanan tidak bisa berkontraksi dengan optimal ,
terjadi bendungan diatrium kanan dan venakapa superior dan inferiordan tampak
gejal yang ada adalah udemaperifer, hepatomegali, splenomegali, dan tampak
nyata penurunan tekanan darah yang cepat., hal ini akibaat vetrikel kanan pada
saat sisitol tidak mampu mempu darah keluar sehingga saat berikutnya tekanan
akhir diatolik ventrikel kanan makin meningkat demikin pula mengakibatkan
tekanan dalam atrium meninggi diikuti oleh bendungan darah vena kava supperior
dan vena kava inferior serta selruh sistem vena tampak gejal klinis adalah
erjadinya bendungan vena jugularis eksterna, bven hepatika (tejadi
hepatomegali, vena lienalis (splenomegali) dan bendungan-bedungan pada pada
ena-vena perifer. Dan apabila tekanan hidristik pada di pembuluh kapiler
meningkat melampui takanan osmotik plasma maka terjadinya edema perifer.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PATOFISIOLOGI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan kontraktilitas</span> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">miokardium ventrikel kiri yang menurun pada gagal jantung
akan mengganggu kemampuan pengosongan ventrikel, sehingga volume residu
ventrikel menjadi meningkat akibat berkurangnya stroke volume yang diejeksikan
oleh ventrikel kiri tersebut. Dengan meningkatnya EDV ( End Diastolic Volume ),
maka terjadi pula peningkatan LVEDP ( Left Ventricle End Diastolic Pressure ),
yang mana derajat peningkatannya bergantung pada kelenturan
ventrikel. Oleh karena selama diastol
atrium dan ventrikel berhubungan
langsung, maka peningkatan LVEDP akan meningkatkan LAP ( Left Atrium Pressure ),
sehingga tekanan kapiler dan vena
paru-paru juga akan meningkat. Jika tekanan hidrostatik
di kapiler paru-paru melebihi tekanan onkotik vaskular, maka akan terjadi
transudasi cairan ke interstitial dan bila cairan tersebut merembes ke dalam
alveoli, terjadilah edema paru-paru.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">
Peningkatan tekanan vena paru yang kronis dapat meningkatkan tekanan arteri
paru yang disebut dengan hipertensi pulmonari, yang mana hipertensi pulmonari
akan meningkatkan tahanan terhadap ejeksi ventrikel kanan. Bila proses yang
terjadi pada jantung kiri juga terjadi pada jantung kanan, akhirnya akan
terjadi kongesti sistemik dan edema (Carleton,P.F dan M.M. O’Donnell,
1995 ; Ignatavicius and Bayne, 1997 ). </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berdasarkan
hubungan antara aktivitas tubuh dengan keluhan dekompensasi dapat dibagi
berdasarkan klisifikasi sebagai berikut (kategori NYHA):</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo12; text-align: justify; text-indent: -50.7pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">I.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pasien dg P. Jantung tetapi tidak
memiliki keluhan pd kegiatan sehari-hari</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">II. Pasien dengan penyakit jantung yang
menimbulkan hambtan aktivitas hanya sedikit, akan tetapi jika ada kegaiatn
berlebih akan menimbulkan capek, berdebar, sesak serta angina</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">III. Pasien dengan penyakit jantung dimana
aktivitas jasmani sangat terbatas dan hanya merasa sehat jika beristirahat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">IV. Pasien dengan penyakit jantung yang
sedikit saja bergerak langsung menimbulkan sesak nafas atau istirahat juga
menimbulkan sesak nafas.</span></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">D.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TANDA</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <b>DAN</b> <b>GEJALA</b></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 3.3pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dampak dari
cardiak output dan kongesti yang terjadi sisitem vena atau sisitem pulmonal
antara lain :</span></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l5 level1 lfo4; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lelah</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l5 level1 lfo4; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Angina</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cemas</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Oliguri. Penurunan aktifitas GI</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kulit dingin dan pucat</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda dan gejala yang disebakan
oleh kongesti balikdari ventrikel kiri, antaralai :</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dyppnea</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Batuk</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Orthopea</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Reles paru</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil x-ray memperlihatkan
kongesti paru</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda-tanda dan gejala kongesti
balik ventrikel kanan :</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Edema perifer</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Distensi vena leher</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hari membesar</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Peningkatan central venous pressure (CPV</span></li>
</ul>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">E.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMERIKSAAN DIAGNOSTIK</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<ol start="1" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l15 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluhan
penderita berdasarkan tanda dan gejala klinis</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l15 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan
fisik EKG untuk melihat ada tidaknya infark myocardial akut, dan guna
mengkaji kompensaai sepperti hipertropi ventrikel</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l15 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Echocardiografi
dapat membantu evaluasi miokard yang iskemik atau nekrotik pada penyakit
jantung kotoner</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l15 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Film
X-ray thorak untuk melihat adanya kongesti pada paru dan pembesaran
jantung</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l15 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">esho-cardiogram,
gated pool imaging, dan kateterisasi arteri polmonal.utuk menyajikan data
tentang fungsi jantung</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">F.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENATALAKSANAAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 21.3pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada dasarnya pengobnatan penyakit decompensasi cordis
adalah sbb:</span></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l16 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemenuhan kebutuhan oksigen</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan faktor pencetus</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Istirahat</span></div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l3 level1 lfo3; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perbaikan suplai oksigen
/mengurangi kongesti</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l12 level1 lfo5; mso-margin-bottom-alt: auto; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan dengan oksigen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l12 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengaturan
posisi pasien deni kebcaran nafas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l12 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peningkatan
kontraktilitas myocrdial (obat-obatan inotropis positif)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l12 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penurunan
preload (pembatan sodium, diuretik, obat-obatan, dilitasi vena)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l12 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penurunan
afterload (obat0obatan dilatasi arteri, obat dilatasi arterivena, inhibitor ACE</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">G.<span style="font: 7pt "Times New Roman";">
</span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMERIKSAAN
PENUNJANG</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level2 lfo15; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Foto polos dada</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proyeksi
A-P; konus pulmonalis menonjol, pinggang jantung hilang, cefalisasi arteria
pulmonalis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo16; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proyeksi
RAO; tampak adanya tanda-tanda pembesaran atrium kiri dan pembesaran ventrikel kanan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level2 lfo15; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">EKG</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: .55pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Irama
sinus atau atrium fibrilasi, gel. mitral yaitu gelombang P yang melebar serta
berpuncak dua serta tanda RVH, LVH jika lanjut usia cenderung tampak gambaran
atrium fibrilasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level2 lfo15; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kateterisasi jantung dan Sine Angiografi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: .55pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Didapatkan
gradien tekanan antara atrium kiri dan ventrikel kiri pada saat distol. Selain
itu dapat dideteksi derajat beratnya hipertensi pulmonal. Dengan mengetahui
frekuensi denyut jantung, besar curah jantung serta gradien antara atrium kiri
dan ventrikel kiri maka dapat dihitung luas katup mitral.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: .55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: .55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">H.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KONSEP
ASUHAN KEPERAWATAN</span></b></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l6 level1 lfo13; mso-outline-level: 5; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian</span></b></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level2 lfo14; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aktivitas
dan Istirahat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala : Mengeluh lemah, cepat
lelah, pusing, rasa berdenyut dan berdebar. Mengeluh sulit tidur (ortopneu,
dispneu paroksimal nokturnal, nokturia, keringat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">malam
hari).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda:
Takikardia, perubahan tekanan darah, pingsan karena kerja, takpineu, dispneu.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level2 lfo14; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirkulasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala: Menyatakan memiliki riwayat
demam reumatik hipertensi, kongenital: kerusakan arteial septal, trauma dada,
riwayat murmur jantung dan palpitasi, serak, hemoptisisi, batuk dengan/tanpa
sputum, riwayat anemia, riwayat shock hipovolema.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda: Getaran sistolik pada apek,
bunyi jantung; S1 keras, pembukaan yang keras, takikardia. Irama tidak teratur;
fibrilasi arterial.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level2 lfo14; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Integritas<b>
</b>Ego</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda: menunjukan kecemasan;
gelisah, pucat, berkeringat, gemetar. Takut akan kematian, keinginan mengakhiri
hidup, merasa tidak berguna. kepribadian neurotik,</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level2 lfo14; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Makanan/Cairan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 13.65pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala:
Mengeluh terjadi perubahan berat badan, sering penggunaan diuretik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda: Edema umum, hepatomegali dan
asistes, pernafasan payah dan bising terdengar krakela dan mengi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level2 lfo14; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Neurosensoris</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala: Mengeluh kesemutan, pusing</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda:
Kelemahan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level2 lfo14; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pernafasan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala: Mengeluh sesak, batuk
menetap atau nokturnal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda: Takipneu, bunyi nafas;
krekels, mengi, sputum berwarna bercak darah, gelisah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level2 lfo14; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keamanan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala:
Proses infeksi/sepsis, riwayat operasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda:
Kelemahan tubuh</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level2 lfo14; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyuluhan/pembelajaran</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala:
Menanyakan tentang keadaan penyakitnya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda:
Menunjukan kurang informasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 13.65pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l6 level1 lfo13; mso-outline-level: 5; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemungkinan diagnosa
keperawatan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
</ol>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l9 level1 lfo17; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan pertukaran gas berhubungan
dengan perubahan membrane kapiler-alveoli</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l9 level1 lfo17; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan perfusi jaringan berhubungan
dengan penurunan suplai oksigen sekunder penurunan cardiac output</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l9 level1 lfo17; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelebihan volume cairan berhubungan
dengan menurunnya laju filtrasi glomerulus</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l9 level1 lfo17; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intoleransi aktivitas berhubungan dengan
penurunan kekuatan otot, penurunan metabolism energy sekunder penurunan suplay
oksigen</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 78.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<br /></div>
<ol start="3" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l6 level1 lfo13; mso-outline-level: 5; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi Keperawatan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></li>
</ol>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; margin-left: 38.25pt; width: 548px;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34"><div align="center" class="MsoListParagraphCxSpFirst" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">No</span></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 35.05pt;" valign="top" width="47"><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Dx</span></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 166.85pt;" valign="top" width="222"><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tujuan dan Keriteria
Hasil</span></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 160.35pt;" valign="top" width="214"><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Intervensi</span></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.5pt;" valign="top" width="31"><div align="center" class="MsoListParagraphCxSpLast" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">ttd</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34"><div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 35.05pt;" valign="top" width="47"><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">I</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 166.85pt;" valign="top" width="222"><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">setelah dilakuakn asuhan keperawatan
selama 3x24 jam diharapkan pertukaran gas efektif dengan keriteria hasil :</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">RR : 16-24 x/menit</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">SaO2 : 95-100 %</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tidak ada retraksi dada</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tidak ada nafas dangkal</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">I:E = 2:1</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 160.35pt;" valign="top" width="214"><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Berikan posisi semifowler</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Berikan terapi O2 sesuai indikasi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau frekuensi pernafasan,
upaya bernafas</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kaji bunyi nafas, warna kulit,
status mental</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau AGD</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau oksimetri nadi untuk
status oksigenasi</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.5pt;" valign="top" width="31"><div class="MsoListParagraphCxSpLast" style="margin-left: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34"><div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 35.05pt;" valign="top" width="47"><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 166.85pt;" valign="top" width="222"><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Setelah dilakukan tindakan keperawatan
selama 3x24 jam diharapkan perfusi jaringan membaik dengan criteria hasil :</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tidak ada sianosis</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tidak ada odema</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">CRT < 3 detik</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Turgor kulit elastic</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 160.35pt;" valign="top" width="214"><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau status neurologis</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau fungsi haemodinamik</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kaji oksigenasi dengan oksimetri</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau hasil laboratorium bilirubin,
BUN, kreatinin</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kaji warna kulit,suhu,adanya
diaferosis</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kolaborasi untuk pemberian obat
sesuai indikasi</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.5pt;" valign="top" width="31"><div class="MsoListParagraphCxSpLast" style="margin-left: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34"><div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 35.05pt;" valign="top" width="47"><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">III</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 166.85pt;" valign="top" width="222"><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">setelah dilakukan tindakan keperawatan
selama 3x24 jam diharapkan terjadi keseimbangan cairan dengan keriteria hasil
:</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mukosa lembab</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Turgor kulit baik</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Balance cairan</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Odem berkurang/tidak ada</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 160.35pt;" valign="top" width="214"><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Batasi pemberian cairan</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau laporan hasil laboratorium</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau kelembaban kulit dan
turgor</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau masukan dan haluaran</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pantau tekanan darah dan nadi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Berikan posisi trendelenberg</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Berikan obat sesuai indikasi</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.5pt;" valign="top" width="31"><div class="MsoListParagraphCxSpLast" style="margin-left: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34"><div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 35.05pt;" valign="top" width="47"><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">IV</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 166.85pt;" valign="top" width="222"><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">setelah dilakukan tindakan keperawatan
selama 3x24 jam diharapkan tidak terjadi gangguan intoleransi aktivitas
dengan keriteria hasil :</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Klien mampu melakukan ADL secara
mandiri</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Klien nyaman dan relax</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 160.35pt;" valign="top" width="214"><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Evaluasi keadaan dan tingkat
kesadaran klien</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kaji tingkat kemampuan aktivitas
klien</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Anjurkan kepada klien untuk
memperbanyak tirah baring</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Batasi pengunjung dan atau
kunjungan klien</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Berikan lingkungan yang tenang
dan nyaman</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Anjurkan pada klien untuk jangan
mengedan defekasi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bantu klien dalam memenuhi ADL</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">-<span style="font: 7pt "Times New Roman";">
</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Latih ROM aktif dan gerak aktif
klien</span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-top-alt: solid black .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.5pt;" valign="top" width="31"><div class="MsoListParagraphCxSpLast" style="margin-left: 0cm; mso-add-space: auto; text-align: justify;">
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;">
</div>
<div align="center" class="MsoListParagraph" style="line-height: 150%; margin-left: 18.0pt; mso-add-space: auto; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAFTAR
PUSTAKA</span></b></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Baradero,
M dkk. 2008. <i style="mso-bidi-font-style: normal;">Klien gangguan
kardiovaskuler. </i>Jakarta: EGC</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Carpenito
J.L. (1998.). <i style="mso-bidi-font-style: normal;">Buku Saku Diagnosa Keperawatan</i>. Edisi 8 EGC. Jakarta.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-indent: -2.0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-indent: -2.0cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Doengoes,
Marylin E. (2000). <i style="mso-bidi-font-style: normal;">Rencana Asuhan Dan Dokumentasi Keperawatan</i><b>.</b>
Edisi 3 EGC. Jakarta.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-indent: -2.0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-indent: -2.0cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Guyton
hall. 2008. <i style="mso-bidi-font-style: normal;">Buku ajar fisiologi
kedokteran ed.2. </i>Jakarta: EGC</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-indent: -2.0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-indent: -2.0cm;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kaplan,
Norman M. (1991). <i>Pencegahan Penyakit Jantung Koroner</i>. EGC Jakarta.</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 12.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mansjoer,
Arif.200.kapita selekta kedokteran.ed 3.jilid 2.jakarta:media Aesculapius</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 12.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Nanda. 2002. <i style="mso-bidi-font-style: normal;">Nursing diagnostic definition and
classification.</i>philadehelphia<i style="mso-bidi-font-style: normal;">:</i>USA</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 12.0pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Smeltzer,
Suzzane C. & Brennda G Bare.<i style="mso-bidi-font-style: normal;"> </i>2002.
<i style="mso-bidi-font-style: normal;">Keperawatan edikal bedah. </i>Jakarta:
EGC</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 12.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tambayong, jean. 2000. <i style="mso-bidi-font-style: normal;">Phaofisiologi untuk keperawatan. </i>Jakarta:
EGC</span></div>
<u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> (</span></u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">1994). <i style="mso-bidi-font-style: normal;">Pedoman Diagnosis Dan Terapi Ilmu Penyakit
Jantung</i><b>.</b> Fakultas Kedokteran Unair & RSUD dr Soetomo
Surabaya </span><br />
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<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-48336541139925409022011-11-10T08:05:00.001-08:002011-11-10T08:08:51.579-08:00PSORIASIS<b style="color: blue;">PSORIASIS</b><br />
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<b>A.<span style="font: 7pt "Times New Roman";">
</span></b><b>Definisi</b></div>
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<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis adalah ganggguan kulit yang ditandai
dengan plaque, bercak, bersisik yang dikenal dengan nama penyakit papulosquamoas.</div>
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( Price, 1994)</div>
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<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis merupakan penyakit radang kulit kronik
dan rekuren / kambuhan, ditandai dengan adanya bercak-bercak kemerahan dengan
sisik putih yang kasar dan tebal.</div>
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(httt//www.sinarharapan.co.id)</div>
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<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis adalah penyakit inflamasi kulit yang
bersifat kronik dan rekuren, yang khas ditandai dengan papula atau plak
eritematosa, kering, batas tegas dan tertutup skuama tebal berlapis-lapis,
berwarna putih keabu-abuan atau putih seperti perak / mika.</div>
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<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis adalah penyakit inflamasi non
infeksius yang kronik pada kulit dimana produksi sel-sel epidermis terjadi
dengan kecepatan <span style="font-family: Symbol;">±</span>
6-9 x lebih besar daripada kecepatan sel normal.</div>
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(Smeltzer, Suzanne)</div>
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<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis adalah masalah kulit di mana bagian
kulit menjadi radang dan ditutupi sisik berwarna perak atau kelabu pada siku,
lutut dan kulit kepala.</div>
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<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis adalah suatu penyakit radang kulit
yang kronis. Penyakit ini ditandai dengan bercak-bercak merah dengan sisik
kasar dan tebal. Penyakit tersebut dianggap sebagai suatu penyakit gangguan
kekebalan tubuh, yang dipengaruhi terutama oleh sel T (salah satu jenis sel darah
putih). Sel T yang teraktivasi akan berinteraksi dengan sel kulit (terutama
keratinosit) dan mengakibatkan pembentukan kulit yang tebal dan bersisik. </div>
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(www.suarapembaharuan.com)</div>
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<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis adalah sejenis penyakit kulit kronis
yang tidak menular, sering kambuh, yang disebabkan oleh proses autoimun dan
kadang-kadang dapat diturunkan.</div>
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<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis adalah sejenis penyakit kulit yang
penderitanya mengalami proses pergantian kulit yang terlalu cepat. Biasanya
bentuk kulit bersisik. Kemunculan penyakit ini terkadang untuk jangka waktu
lama atau timbul/hilang, penyakit ini secara klinis sifatnya tidak mengancam
jiwa dan tidak menular tetapi karena timbulnya dapat terjadi pada bagian tubuh
mana saja sehingga dapat menurunkan kualitas hidup serta mengganggu kekuatan
mental seseorang bila tidak dirawat dengan baik.</div>
<div align="right" class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: right;">
(www.psoriasis.or.id)</div>
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Gambar
2. Contoh Penyakit Psoriasis.</div>
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<br /></div>
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<b>B.<span style="font: 7pt "Times New Roman";">
</span></b><b>Etiologi</b></div>
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Penyebab psoriasis sampai saat ini belum diketahui.
Diduga penyakit ini diwariskan secara poligenik. Walaupun sebagian besar
penderita psoriasis timbul secara spontan, namun pada beberapa penderita
dijumpai adanya faktor pencetus antara lain:</div>
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1.<span style="font: 7pt "Times New Roman";">
</span>Trauma</div>
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Psoriasis pertama kali timbul pada tempat-tempat yang terkena trauma,
garukan, luka bekas operasi, bekas vaksinasi, dan sebagainya. Kemungkinan hal
ini merupakan mekanisme fenomena Koebner. Khas pada psoriasis timbul setelah
7-14 hari terjadinya trauma.</div>
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2.<span style="font: 7pt "Times New Roman";">
</span>Infeksi</div>
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Pada anak-anak terutama infeksi Streptokokus hemolitikus sering
menyebabkan psoriasis gutata. Psoriasis juga timbul setelah infeksi kuman lain
dan infeksi virus tertentu, namun menghilang setelah infeksinya sembuh.</div>
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3.<span style="font: 7pt "Times New Roman";">
</span>Iklim</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Beberapa kasus cenderung menyembuh pada musim panas, sedangkan pada musim
penghujan akan kambuh.</div>
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4.<span style="font: 7pt "Times New Roman";">
</span>Faktor endokrin</div>
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Insiden tertinggi pada masa pubertas dan menopause. Psoriasis cenderung
membaik selama kehamilan dan kambuh serta resisten terhadap pengobatan setelah
melahirkan. Kadang-kadang psoriasis pustulosa generalisata timbul pada waktu
hamil dan setelah pengobatan progesteron dosis tinggi.</div>
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5.<span style="font: 7pt "Times New Roman";">
</span>Sinar matahari</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Walaupun umumnya sinar matahari bermanfaat bagi penderita psoriasis namun
pada beberapa penderita sinar matahari yang kuat dapat merangsang timbulnya
psoriasis. Pengobatan fotokimia mempunyai efek yang serupa pada beberapa
penderita.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l14 level2 lfo1; text-align: justify; text-indent: -18.0pt;">
6.<span style="font: 7pt "Times New Roman";">
</span>Metabolik</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Hipokalsemia dapat menimbulkan psoriasis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l14 level2 lfo1; text-align: justify; text-indent: -18.0pt;">
7.<span style="font: 7pt "Times New Roman";">
</span>Obat-obatan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l14 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Antimalaria seperti mepakrin dan klorokuin
kadang-kadang dapat memperberat psoriasis, bahkan dapat menyebabkan
eritrodermia. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l14 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Pengobatan dengan kortikosteroid topikal atau
sistemik dosis tinggi dapat menimbulkan efek “withdrawal”. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l14 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Lithium yang dipakai pada pengobatan penderita
mania dan depresi telah diakui sebagai pencetus psoriasis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l14 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Alkohol dalam jumlah besar diduga dapat memperburuk
psoriasis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l14 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Hipersensitivitas terhadap nistatin, yodium,
salisilat dan progesteron dapat menimbulkan psoriasis pustulosa generalisata.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
Berdasarkan penelitian para dokter, ada beberapa hal yang diperkirakan
dapat memicu timbulnya Psoriasis, antara lain adalah : </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l2 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Garukan/gesekan dan tekanan yang berulang-ulang
, misalnya pada saat gatal digaruk terlalu kuat atau penekanan anggota tubuh
terlalu sering pada saat beraktivitas. Bila Psoriasis sudah muncul dan kemudian
digaruk/dikorek, maka akan mengakibatkan kulit bertambah tebal. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l2 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Obat telan tertentu antara lain obat anti
hipertensi dan antibiotik. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l2 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Mengoleskan obat terlalu keras bagi kulit. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l2 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Emosi tak terkendali. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l2 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Makanan berkalori sangat tinggi sehingga badan
terasa panas dan kulit menjadi merah , misalnya mengandung alcohol. </div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l14 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<b>C.<span style="font: 7pt "Times New Roman";">
</span></b><b>Macam-Macam Psoriasis</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Berdasarkan bentuk lesi, dikenal bermacam-macam
psoriasis antara lain:</div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 41.4pt; width: 480px;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0; mso-yfti-lastrow: yes;">
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 26.9pt;" valign="top" width="36"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
a.</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
b.</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
c.</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
d.</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
e.</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
f.</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
g.</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
h.</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
i.</div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 134.15pt;" valign="top" width="179"><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
punctata</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
folikularis</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
guttata</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
numularis</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
girata</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
anularis</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
diskoidea</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
ostracea</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Psoriasis
rupioides</div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 14.15pt;" valign="top" width="19"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
:</div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 184.8pt;" valign="top" width="246"><div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi sebesar
jarum pentul atau milier.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi dengan
skuama tipis terletak pada muara folikel rambut.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi sebesar
tetesan air.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi sebesar
uang logam.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi sebesar
daun.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi melingka
berbentuk seperti cincin karena adanya involusi dibagian tengahnya.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi merupakan
bercak solid yang menetap.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi berupa
penebalan kulit yang kasar dan tertutup lembaran-lembaran skuama mirip kulit
tiram.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
Lesi berkrusta
mirip rupia sifilitika.</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Tipe-tipe psoriasis. Psoriasis terbagi atas: </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">ü<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis vulgaris: bentuk ini ialah jenis yang
paling umum karena itu disebut vulgaris, dinamakan pula tipe plak karena
lesi-lesinya berbentuk plak. Tempat predileksinya seperti yang telah
diterangkan di atas. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">ü<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis gutata: diameter kelainan biasanya
tidak melebihi 1 cm. Timbulnya mendadak dan mengenai seluruh badan, umumnya
setelah infeksi di saluran napas bagian atas sehabis influenza atau morbili
(campak), terutama pada anak dan dewasa muda. </div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
</div>
<table align="left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td height="4" width="168"><br /></td>
</tr>
<tr>
<td><br /></td>
<td><img height="180" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image008.jpg" width="192" /></td>
</tr>
</tbody></table>
<br />
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Gambar
3. Contoh psoriasis Gutata</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">ü<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis putulosa: gejala awalnya ialah kulit
yang nyeri disertai gejala umum berupa demam, mudah capek, mual, dan nafsu
makan menurun. Kelainan kulit psoriasis yang telah ada makin merah. Setelah
beberapa jam timbul agak bengkak dan bintil-bintil bernanah pada bercak merah
tersebut. Kelainan-kelainan semacam itu akan terus muncul dan dapat menjadi
eritroderma. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">ü<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis eritrodermis: dapat disebabkan oleh
pengobatan topikal yang terlalu kuat atau oleh penyakitnya sendiri yang meluas.
Biasanya kelainan kulit yang khas untuk psoriasis tidak tampak lagi karena
terdapat kemerahan dan bersisik tebal yang menyeluruh. Ada kalanya kelainan
kulit psoriasis masih tampak samar-samar, yakni lebih merah dan kulitnya lebih
meninggi. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">ü<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis kuku: menyerang dan merusak kuku.
Permukaan kuku tampak lekukan-lekukan kecil. Jenis ini termasuk yang bandel,
sehingga penderita sulit sembuh. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">ü<span style="font: 7pt "Times New Roman";">
</span></span>Psoriasis artritis: penyakit ini dapat pula
disertai peradangan pada sendi, sehingga sendi terasa nyeri, membengkak dan
kaku, persis seperti gejala rematik. Pada tahap ini, penderita harus segera
ditolong agar sendi-sendinya tidak sampai keropos.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Berdasarkan lokalisasi lesi maka dikenal bentuk
psoriasis atipik seperti:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
1.<span style="font: 7pt "Times New Roman";">
</span>Psoriasis digitalis atau interdigitalis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
2.<span style="font: 7pt "Times New Roman";">
</span>Lesi verukosa terutama di tungkai bawah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
3.<span style="font: 7pt "Times New Roman";">
</span>Lesi dengan distribusi seperti sarung tangan atau kaos
kaki.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
4.<span style="font: 7pt "Times New Roman";">
</span>Psoriasis fleksural atau inversus bila lesi didapatkan
di daerah fleksor atau lipatan-lipatan tubuh misalnya lipat paha, aksila,
lipatan di bawah payudara dan lainnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
5.<span style="font: 7pt "Times New Roman";">
</span>Psoriasis seboreik bila lesi didapatkan di daerah
seboreik seperti kulit kepala, alis mata, belakang telinga dan sebagainya.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l14 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<b>D.<span style="font: 7pt "Times New Roman";">
</span></b><b>Manifestasi Klinik</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Lesi muncul sebagai bercak-bercak merah menonjol pada
kulit yang ditutupi oleh sisik berwarna perak. Bercak-bercak bersisik tersebut
terbentuk karena penumpukan kulit yang hidup dan mati akibat peningkatan
kecepatan pertumbuhan serta pergantian sel-sel kulit yang sangat besar. Jika
sisik tersebut dikerok, maka terlihat dasar lesi yang berwarna merah gelap dengan
titik-titik perdarahan. Bercak-bercak ini tidak basah dan bisa terasa gatal
atau tidak gatal.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Psoriasis ditandai dengan hiperkeratosis dan penebalan
epidermis kulit serta proses radang, sehingga timbul skuamasi (pengelupasan)
dan indurasi eritematosa (kulit meradang dan kemerahan). Menyerang kulit, kuku,
mukosa dan sendi, tetapi tidak pada rambut. Pada umumnya tidak membehayakan
jiwa, kecuali yang mengalami komplikasi, namun penyakit ini sangat mengganggu
kualitas hidup.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Kulit penderita psoriasis awalnya tampak seperti
bintik merah yang makin melebar dan ditumbuhi sisik lebar putih berlapis-lapis.
Tumbuhnya tidak selalu diseluruh bagian kulit tubuh kadang-kadang hanya timbul
pada tempat-tempat tertentu saja, karena pergiliran sel-sel kulit bagian
lainnya berjalan normal. Psoriasis pada kulit kepala dapat menyerupai ketombe,
sedangkan pada lempeng kuku tampak lubang-lubang kecil rapuh atau keruh.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Penyakit psoriasis dapat disertai dengan / tanpa rasa
gatal. Kulit dapat membaik seperti kulit normal lainnya setelah warna
kemerahan, putih atau kehitaman bekas psoriasis. Pada beberapa jenis psoriasis,
komplikasi yang diakibatkan dapat menjadi serius, seperti pada psoriasis
artropi yaitu psoriasis yang menyerang sendi, psoriasis bernanah (psoriasis
postulosa) dan terakhir seluruh kulit akan menjadi merah disertai badan
menggigil (eritoderma).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
Gejala dari psoriasis antara lain:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Mengeluh gatal ringan </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Bercak-bercak eritema yang meninggi, skuama
diatasnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Terdapat fenomena tetesan lilin </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Menyebabkan kelainan kuku </div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l14 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<b>E.<span style="font: 7pt "Times New Roman";">
</span></b><b>Patofisiologi</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Patogenesis terjadinya psoriasis, diperkirakan karena:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l8 level1 lfo9; text-align: justify; text-indent: -18.0pt;">
1.<span style="font: 7pt "Times New Roman";">
</span>Terjadi peningkatan “turnover” epidermis atau kecepatan
pembentukannya dimana pada kulit normal memerlukan waktu 26-28 hari, pada
psoriasis hanya 3-4 hari sehingga gambaran klinik tampak adanya skuama dimana
hiperkeratotik. Disamping itu pematangan sel-sel epidermis tidak sempurna.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l8 level1 lfo9; text-align: justify; text-indent: -18.0pt;">
2.<span style="font: 7pt "Times New Roman";">
</span>Adanya faktor keturunan ditandai dengan perjalanan
penyakit yang kronik dimana terdapat penyembuhan dan kekambuhan spontan serta
predileksi lesinya pada tempat-tempat tertentu.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l8 level1 lfo9; text-align: justify; text-indent: -18.0pt;">
3.<span style="font: 7pt "Times New Roman";">
</span>Perubahan-perubahan biokimia yang terjadi pada
psoriasis meliputi:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l8 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Peningkatan replikasi DNA.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l8 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Berubahnya kadar siklik nukleotida.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l8 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
c.<span style="font: 7pt "Times New Roman";">
</span>Kelainan prostaglandin dan prekursornya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l8 level2 lfo9; text-align: justify; text-indent: -18.0pt;">
d.<span style="font: 7pt "Times New Roman";">
</span>Berubahnya metabolisme karbohidrat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Normalnya sel kulit akan matur pada 28-30 hari dan
kemudian terlepas dari permukaan kulit. Pada penderita psoriasis, sel kulit
akan matur dan menuju permukaan kulit pada 3-4 hari, sehingga akan menonjol dan
menimbulkan bentukan peninggian kumpulan plak berwarna kemerahan. Warna
kemerahan tersebut berasal dari peningkatan suplai darah untuk nutrisi bagi sel
kulit yang bersangkutan. Bentukan berwarna putih seperti tetesan lilin (atau
sisik putih) merupakan campuran sel kulit yang mati. Bila dilakukan kerokan
pada permukaan psoriasis, maka akan timbul gejala koebner phenomenon. Terdapat
banyak tipe dari psoriasis, misalnya plaque, guttate, pustular, inverse, dan
erythrodermic psoriasis. Umumnya psoriasis akan timbul pada kulit kepala, siku
bagian luar, lutut, maupun daerah penekanan lainnya. Tetapi psoriasis dapat
pula berkembang di daerah lain, termasuk pada kuku, telapak tangan, genitalia,
wajah, dll. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Pemeriksaan histopatologi pada biopsi kulit penderita
psoriasis menunjukkan adanya penebalan epidermis dan stratum korneum dan
pelebaran pembuluh-pembuluh darah dermis bagian atas. Jumlah sel-sel basal yang
bermitosis jelas meningkat. Sel-sel yang membelah dengan cepat itu bergerak
dengan cepat ke bagian permukaan epidermis yang menebal. Proliferasi dan
migrasi sel-sel epidermis yang cepat ini menyebabkan epidermis menjadi tebal
dan diliputi keratin yang tebal (sisik yang berwarna seperti perak).
Peningkatan kecepatan mitosis sel-sel epidermis ini agaknya antara lain
disebabkan oleh kadar nukleotida siklik yang abnormal, terutama adenosin
monofosfat (AMP) siklik dan guanosin monofosfat (GMP) sikli. Prostaglandin dan
poliamin juga abnormal pada penyakit ini. Peranan setiap kelainan tersebut
dalam mempengaruhi pembentukan plak psoriatik belum dapat dimengerti secara
jelas.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l14 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<b>F.<span style="font: 7pt "Times New Roman";">
</span></b><b>Komplikasi</b></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;">Psoriasis Pustulosa</li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
Kadang-kadang diatas makula eritematosa pada psoriasis
timbul pustula-pustula kecil dengan ukuran 1-2 mm. keadaan ini dikenal dengan
psoriasis postula.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Ada 2 bentuk psoriasis postula:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l10 level2 lfo4; text-align: justify; text-indent: -18.0pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Psoriasis postulosa generalisata (bentuk Von Zumbusch).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify; text-indent: 18.0pt;">
Bentuk ini bersifat akut, merupakan bentuk sistemik
dari psoriasis dengan ciri eritematosa disertai demam dan gejala penyakit
sistemik yang lain. Postula dapat timbul diatas lesi psoriasis atau pada kulit
sehat yang mengalami eritema sebelumnya. Lesi ini menyebar dengan cepat dan
timbulnya bergelombang. Postula yang timbul tersusun berkelompok atau diskret.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify; text-indent: 18.0pt;">
Kuku menebal dan pecah-pecah karena adanya nanah.
Mukosa mulut dan lidah dapat mengalami kelainan. Kematian terjadi karena toksik
atau infeksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l10 level2 lfo4; text-align: justify; text-indent: -18.0pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Psoriasis postulosa lokalisata (bentuk Barber)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify; text-indent: 18.0pt;">
Bentuk ini bersifat kronik dan sangat resisten
terhadap pengobatan. Biasanya menyerang telapak tangan dan telapak kaki serta
distribusinya simetris. Lesi berupa postula diatas plak eritematosa, berskuama.
Postula yang masih baru berwarna kuning, kemudian berubah menjadi kuning
kecoklatan dan bila postula mengering berwarna coklat gelap. Akhirnya postula
yang kering ini mengelupas. Kadang-kadang timbul rasa gatal tetapi lebih sering
timbul keluhan seperti rasa terbakar.</div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;">Psoriasis arthritis</li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
Biasanya mengenai sendi-sendi interfalangeal distal
dari jari tangan dan kaki. Pada stadium akut, sendi yang terserang menjadi
bengkak, keras dan sakit. Bila berlangsung lama dapat menimbulkan kerusakan
tulang dan synovial eusion, menyebabkan pemendekan tulang dan hal ini
mengakibatkan pergerakan sendi menjadi sulit, jari memendek dan kaku dalam
posisi fleksi. Secara rotgenologik tampak sendi yang atrofi dengan permulaan
osteoporosis diikuti peningkatan densitas tulang, penyempitan rongga persendian
dan erosi permukaan sendi.</div>
<ol start="3" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l10 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;">Psoriasis eritrodermia</li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
Psoriasis yang kronik dan luas dengan perjalanan
penyakit yang lama dapat berkembang menjadi eritodermia. Seluruh permukaan
tubuh menjadi merah dan tertutup skuama putih yang halus. Umumnya bentuk ini
timbul akibat pemakaian obat topikal atau penyinaran yang berlebihan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Biasanya sulit diobati dan bila pengobatan berhasil maka erupsi
eritodermia menghilang dan lesi psoriasis yang khas akan muncul kembali.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l14 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<b>G.<span style="font: 7pt "Times New Roman";">
</span></b><b>Penatalaksanaan</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Tujuan penatalaksanaan adalah untuk memperlambat
pergantian epidermis, meningkatkan resolusi lesi psoriatik dan mengendalikan
penyakit tersebut. Pendekatan terapeutik harus berupa pendekatan yang dapat
dipahami oleh pasien, pendekatan ini harus bisa diterima secara kosmetik dan
tidak mempengaruhi cara hidup pasien. Terapi psoriasis akan melibatkan komitmen
waktu dan upaya oleh pasien dan mungkin pula keluarganya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Ada tiga terapi yang standar: topikal, intralesi dan
sistemik.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span><b>Terapi
topikal</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
Preparat yang dioleskan secara topikal digunakan untuk
melambatkan aktivitas epidermis yang berlebihan tanpa mempengaruhi jaringan
lainnya. Obat-obatannya mencakup preparat ter, anthralin, asam salisilat dan
kortikosteroid. Terapi dengan preparat ini cenderung mensupresi epidermopoisis
(pembentukan sel-sel epidermis).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Formulasi ter</b> mencakup losion, salep, pasta,
krim dan sampo. Rendaman ter dapat menimbulkan retardasi dan inhibisi terhadap
pertumbuhan jaringan psoriatik yang cepat. Terapi ter dapat dikombinasikan
dengan sinar ultraviolet-B yang dosisnya ditentukan secara cermat sehingga
menghasilkan radiasi dengan panjang gelombang antara 280 dan 320 nanometer
(nm). Selama fase terapi ini pasien dianjurkan untuk menggunakan kacamata
pelindung dan melindungi matanya. Pemakaian sampo ter setiap hari yang diikuti
dengan pengolesan losion steroid dapat digunakan untuk lesi kulit kepala.
Pasien juga diajarkan untuk menghilangkan sisik yang berlebihan dengan
menggosoknya memakai sikat lunak pada waktu amndi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Anthralin </b>adalah preparat (Anthra-Derm,
Dritho-Crème, Lasan) yang berguna untuk mengatasi plak psoriatik yang tebal
yang resisten terhadap preparat kortikosteroid atau preparat ter lainnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Kortikosteroid</b> topikal dapat dioleskan untuk
memberikan efek antiinflamasi. Setelah obat ini dioleskan, bagian kulit yang
diobati ditutup dengan kasa lembaran plastik oklusif untuk menggalakkan
penetrasi obat dan melunakkan plak yang bersisik.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span><b>Terapi
intralesi</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Penyuntikan triamsinolon asetonida intralesi</b>
(Aristocort, Kenalog-10, Trymex) dapat dilakukan langsung kedalam berck-bercak
psoriasis yang terlihat nyata atau yang terisolasi dan resisten terhadap bentuk
terapi lainnya. Kita harus hati-hati agar kulit yang normal tidak disuntuik
dengan obat ini.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span><b>Terapi
sistemik</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Metotreksat</b> bekerja dengan cara menghambat
sintesis DNA dalam sel epidermis sehingga mengurangi waktu pergantian epidermis
yang psoriatik. Walaupun begitu, obat ini bisa sangat toksik, khususnya bagi
hepar yang dapat mengalamim kerusakan yang irreversible. Jadi, pemantauan
melalui pemeriksaan laboratorium harus dilakukan untuk memastikan bahwa sistem
hepatik, hematopoitik dan renal pasien masih berfungsi secara adekuat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
Pasien tidak boleh minum minuman alkohol selama
menjalani pengobatan dengan metotreksat karena preparat ini akan memperbesar
kemungkinan kerusakn hepar. Metotreksat bersifat teratogenik (menimbulkan cacat
fisik janin) pada wanita hamil.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Hidroksiurea</b> menghambat replikasi sel dengan
mempengaruhi sintesis DNA. Monitoring pasien dilakukan untuk memantau
tanda-tanda dan gejal depresi sumsum tulang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Siklosporin A</b>, suatu peptida siklik yang
dipakai untuk mencegah rejeksi organ yang dicangkokkan, menunjukkan beberapa
keberhasilan dalam pengobatan kasus-kasus psoriasis yang berat dan resisten
terhadap terapi. Kendati demikian, penggunaannya amat terbatas mengingat efek
samping hipertensi dan nefroktoksisitas yang ditimbulkan (Stiller, 1994).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Retinoid oral</b> (derivat sintetik vitamin A dan
metabolitnya, asam vitamin A) akan memodulasi pertumbuhan serta diferensiasi
jaringan epiterial, dan dengan demikian pemakaian preparat ini memberikan
harapan yang besar dalam pengobatan pasien psoriasis yang berat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Fotokemoterapi</b>. Terapi psoriasis yang sangat
mempengaruhi keadaan umum pasien adalah psoralen dan sinar ultraviolet A
(PUVA). Terapi PUVA meliputi pemberian preparat fotosensitisasi (biasanya
8-metoksipsoralen) dalam dosis standar yang kemudian diikuti dengan pajanan
sinar ultraviolet gelombang panjang setelah kadar obat dalam plasma mencapai
puncaknya. Meskipun mekanisme kerjanya tidak dimengerti sepenuhnya, namun
diperkirakan ketika kulit yang sudah diobati dengan psoralen itu terpajan sinar
ultraviolet A, maka psoralen akan berkaitan dengan DNA dan menurunkan
proliferasi sel. PUVA bukan terapi tanpa bahaya; terapi ini disertai dengan
resiko jangka panjang terjadinya kanker kulit, katarak dan penuaan prematur
kulit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Terapi PUVA</b> mensyaratkan agar psoralen
diberikan peroral dan setelah 2 jam kemudian diikuti oleh irradiasi sinar
ultraviolet gelombang panjang denagn intensitas tinggi. (sinar ultraviolet
merupakan bagian dari spektrum elektromagnetik yang mengandung panjang
gelombang yang berkisar dari 180 hingga 400 nm).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Terapi sinar ultraviolet B (UVB)</b> juga digunakan
untuk mengatasi plak yang menyeluruh. Terapi ini dikombinasikan dengan terapi
topikal <b>ter </b>batubara (terapi goeckerman). Efek sampingnya serupa dengan
efek samping pada terapi PUVA.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b>Etretinate (Tergison)</b> adalah obat yang relatif
baru (1986). Ia adalah derivat dari Vitamin A. Bisa diminum sendiri atau dikombinasi
dengan sinar ultraviolet. Hal ini dilakukan pada penderita yang sudah bandel
dengan obat obat lainnya yang terdahulu.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Di antara pengobatan tersebut diatas, yang paling
efektif untuk mengobati psoriasis adalah dengan ultraviolet (fototerapi), karena
dengan fototerapi penyakit psoriasis dapat lebih cepat mengalami “clearing”
atau “almost clearing” (keadaan dimana kelainan / gejala psoriasis hilang atau
hampir hilang). Keadaan ini disebut “remisi”. Masa remisi fototerapi tersebut
bisa bertahan lebih lama dibandingkan dengan pengobatan lainnya. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Pengobatan fotokemoterapi, yaitu dengan menggunakan
kombinasi radiasi ultraviolet dan oral psoralen (PUVA), namun kelemahannya
adalah untuk jangka panjang dapat menimbulkan kanker kulit. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Fototerapi UVB konvensional dengan menggunakan sinar
UVB broadband dengan panjang gelombang 290-320 nm. Terapi kurang praktis karana
pasien harus masuk ke dalam light box. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
<span style="height: 155px; left: 0px; margin-left: 108px; margin-top: 136px; position: absolute; width: 140px; z-index: 251623936;"><img height="155" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image010.jpg" width="140" /></span><span style="height: 147px; left: 0px; margin-left: 300px; margin-top: 133px; position: absolute; width: 125px; z-index: 251624960;"><img height="147" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image012.jpg" width="125" /></span>Fototerapi dengan alat Monochromatic
Excimer Light 308 nm (MEL 308 nm) merupakan bentuk fototerapi UVB yang paling
mutakhir dengan menggunakan sinar laser narrowband UVB dengan panjang gelombang
308 nm. Dibandingkan dengan narrowband UVB, MEL 308 nm lebih cepat dan lebih
efektif dalam mengobati psoriasis yang resisten.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Gambar
3. Alat fototerapi</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 18.0pt;">
Beberapa tips
untuk penderita psoriasis : </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l5 level1 lfo6; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Jaga kulit agar tetap berminyak. Minyak, cream,
dan petroleum jelly adalah moisturizer yang baik. Gunakan pelembab bila udara
terasa panas. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l5 level1 lfo6; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Penyinaran dengan sinar matahari akan
menghilangkan psoriasis pada beberapa orang, namun kulit terlebih dulu diolesi
dengan minyak dan dilakukan lubrikasi. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l5 level1 lfo6; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Mandi dengan air panas akan mengurangi sisik
yang timbul. Penggunaan moisturizer segera setelah mandi akan berguna.
Meminimalisasi kontak dengan sabun dan bahan kimia. Gunakan sabun yang sangat
lembut, sabun moisturizing, atau sabun yang bebas pembersih. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l5 level1 lfo6; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Lindungi kulit dari cidera, sebab cidera dapat
memperparah plaque yang timbul.</div>
<div class="MsoNormal">
<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<div class="MsoNormal">
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</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<br />
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<b>H.<span style="font: 7pt "Times New Roman";">
</span></b><b>Pathway</b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
</div>
<table align="left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td height="5" width="2"><br /></td>
</tr>
<tr>
<td><br /></td>
<td><img height="549" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image013.gif" width="854" /></td>
</tr>
</tbody></table>
<br /></div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<br />
<div class="WordSection3">
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="height: 26px; left: 0px; margin-left: 507px; margin-top: 62px; position: absolute; width: 2px; z-index: 251692544;"><img height="26" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image014.gif" width="2" /></span><span style="height: 2px; left: 0px; margin-left: 303px; margin-top: 86px; position: absolute; width: 470px; z-index: 251691520;"><img height="2" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image015.gif" width="470" /></span><span style="height: 15px; left: 0px; margin-left: 766px; margin-top: 87px; position: absolute; width: 12px; z-index: 251688448;"><img height="15" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image016.gif" width="12" /></span><span style="height: 15px; left: 0px; margin-left: 611px; margin-top: 87px; position: absolute; width: 12px; z-index: 251689472;"><img height="15" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image016.gif" width="12" /></span><span style="height: 15px; left: 0px; margin-left: 459px; margin-top: 87px; position: absolute; width: 12px; z-index: 251690496;"><img height="15" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image016.gif" width="12" /></span><span style="height: 15px; left: 0px; margin-left: 299px; margin-top: 87px; position: absolute; width: 12px; z-index: 251687424;"><img height="15" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image016.gif" width="12" /></span><span style="height: 12px; left: 0px; margin-left: 138px; margin-top: 450px; position: absolute; width: 327px; z-index: 251686400;"><img height="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image017.gif" width="327" /></span><span style="height: 302px; left: 0px; margin-left: 137px; margin-top: 155px; position: absolute; width: 2px; z-index: 251685376;"><img height="302" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image018.gif" width="2" /></span><span style="height: 39px; left: 0px; margin-left: 528px; margin-top: 311px; position: absolute; width: 12px; z-index: 251683328;"><img height="39" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image019.gif" width="12" /></span><span style="height: 27px; left: 0px; margin-left: 528px; margin-top: 395px; position: absolute; width: 12px; z-index: 251684352;"><img height="27" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image020.gif" width="12" /></span><span style="height: 66px; left: 0px; margin-left: 467px; margin-top: 425px; position: absolute; width: 138px; z-index: 251677184;">
</span></div>
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="66" style="background: white; border: .75pt solid black; vertical-align: top;" width="138"><span style="left: 0pt; position: absolute; z-index: 251677184;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td><div class="shape" style="padding: 4.35pt 7.95pt 4.35pt 7.95pt;">
<div align="center" class="MsoNormal" style="text-align: center;">
Gangguan
integritas kulit</div>
</div>
</td>
</tr>
</tbody></table>
<span style="left: 0pt; position: absolute; z-index: 251677184;">
</span> </td>
</tr>
</tbody></table>
<span style="height: 12px; left: 0px; margin-left: 602px; margin-top: 450px; position: absolute; width: 171px; z-index: 251682304;"><img height="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image021.gif" width="171" /></span><span style="height: 218px; left: 0px; margin-left: 771px; margin-top: 238px; position: absolute; width: 2px; z-index: 251681280;"><img height="218" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image022.gif" width="2" /></span><span style="height: 74px; left: 0px; margin-left: 762px; margin-top: 239px; position: absolute; width: 2px; z-index: 251680256;"><img height="74" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image023.gif" width="2" /></span><span style="height: 2px; left: 0px; margin-left: 305px; margin-top: 311px; position: absolute; width: 458px; z-index: 251679232;"><img height="2" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image024.gif" width="458" /></span><span style="height: 64px; left: 0px; margin-left: 468px; margin-top: 348px; position: absolute; width: 136px; z-index: 251643392;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="64" style="background: white; vertical-align: top;" width="136"><span style="left: 0pt; position: absolute; z-index: 251643392;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td><div class="shape" style="padding: 3.6pt 7.2pt 3.6pt 7.2pt;">
<div align="center" class="MsoNormal" style="text-align: center;">
Pembentukan plak
psoriatik</div>
</div>
</td>
</tr>
</tbody></table>
<span style="left: 0pt; position: absolute; z-index: 251643392;">
</span> </td>
</tr>
</tbody></table>
<span style="height: 64px; left: 0px; margin-left: 468px; margin-top: 348px; position: absolute; width: 136px; z-index: 251643392;">
</span><span style="height: 26px; left: 0px; margin-left: 305px; margin-top: 287px; position: absolute; width: 2px; z-index: 251678208;"><img height="26" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image014.gif" width="2" /></span><span style="height: 148px; left: 0px; margin-left: 708px; margin-top: 96px; position: absolute; width: 136px; z-index: 251645440;">
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="148" style="background: white; vertical-align: top;" width="136"><span style="left: 0pt; position: absolute; z-index: 251645440;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td><div class="shape" style="padding: 3.6pt 7.2pt 3.6pt 7.2pt;">
<div align="center" class="MsoNormal" style="text-align: center;">
Kelainan
prostaglandin dan perkursornya</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
Psoriasis
postulosa generalisata</div>
</div>
</td>
</tr>
</tbody></table>
<span style="left: 0pt; position: absolute; z-index: 251645440;">
</span> </td>
</tr>
</tbody></table>
</span><span style="height: 208px; left: 0px; margin-left: 552px; margin-top: 96px; position: absolute; width: 136px; z-index: 251641344;">
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="208" style="background: white; vertical-align: top;" width="136"><span style="left: 0pt; position: absolute; z-index: 251641344;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td><div class="shape" style="padding: 3.6pt 7.2pt 3.6pt 7.2pt;">
<div align="center" class="MsoNormal" style="text-align: center;">
Kadar siklik
nukleotida</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;"></span>
AMP</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;"></span>
GMP</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;"></span>
kecepatan mitosis sel basal</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;"></span>
sintesis keratin</div>
</div>
</td>
</tr>
</tbody></table>
<span style="left: 0pt; position: absolute; z-index: 251641344;">
</span> </td>
</tr>
</tbody></table>
</span><span style="height: 64px; left: 0px; margin-left: 396px; margin-top: 96px; position: absolute; width: 136px; z-index: 251640320;">
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="64" style="background: white; vertical-align: top;" width="136"><span style="left: 0pt; position: absolute; z-index: 251640320;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td><div class="shape" style="padding: 3.6pt 7.2pt 3.6pt 7.2pt;">
<div align="center" class="MsoNormal" style="text-align: center;">
Peningkatan
replikasi DNA</div>
</div>
</td>
</tr>
</tbody></table>
<span style="left: 0pt; position: absolute; z-index: 251640320;">
</span> </td>
</tr>
</tbody></table>
</span><span style="height: 208px; left: 0px; margin-left: 240px; margin-top: 96px; position: absolute; width: 136px; z-index: 251644416;">
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="208" style="background: white; vertical-align: top;" width="136"><span style="left: 0pt; position: absolute; z-index: 251644416;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td><div class="shape" style="padding: 3.6pt 7.2pt 3.6pt 7.2pt;">
<div align="center" class="MsoNormal" style="text-align: center;">
Berubahnya
metabolisme karbohidrat</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;"></span>
aliran darah ke sel</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
Lesi</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
Eritema</div>
</div>
</td>
</tr>
</tbody></table>
<span style="left: 0pt; position: absolute; z-index: 251644416;">
</span> </td>
</tr>
</tbody></table>
</span><span style="height: 136px; left: 0px; margin-left: 60px; margin-top: 36px; position: absolute; width: 160px; z-index: 251632128;">
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="136" style="background: white; vertical-align: top;" width="160"><span style="left: 0pt; position: absolute; z-index: 251632128;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td><div class="shape" style="padding: 3.6pt 7.2pt 3.6pt 7.2pt;">
<div align="center" class="MsoNormal" style="text-align: center;">
Faktor keturunan</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
Perjalanan
penyakit yang kronik</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: Symbol;">¯</span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
Lesi</div>
</div>
</td>
</tr>
</tbody></table>
<span style="left: 0pt; position: absolute; z-index: 251632128;">
</span> </td>
</tr>
</tbody></table>
</span><span style="height: 40px; left: 0px; margin-left: 396px; margin-top: 36px; position: absolute; width: 232px; z-index: 251642368;">
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="40" style="background: white; vertical-align: top;" width="232"><span style="left: 0pt; position: absolute; z-index: 251642368;">
</span><br />
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td><div class="shape" style="padding: 3.6pt 7.2pt 3.6pt 7.2pt;">
<div align="center" class="MsoNormal" style="text-align: center;">
Perubahan-perubahan
biokimia</div>
</div>
</td>
</tr>
</tbody></table>
<span style="left: 0pt; position: absolute; z-index: 251642368;">
</span> </td>
</tr>
</tbody></table>
</span>Lanjutan</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
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</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
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<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" style="page-break-before: always;" />
</span>
<br />
<div class="WordSection4">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b>ASUHAN
KEPERAWATAN</b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l12 level1 lfo14; text-align: justify; text-indent: -18.0pt;">
<b>A.<span style="font: 7pt "Times New Roman";">
</span></b><b>Pengkajian</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Berfokus pada cara pasien menghadapi kondisi kulit
yang psoriatik, penampakan kulit “ normal “ dan penampakan lesi kulit.
Manifestasi yang terlihat adalah papula merah bersisik yang menyatu untuk
membentuk plak berbentuk oval dengan batas yang jelas. Sisik atau skuama yang
berwarna putih perak juga terdapat. Daerah kulit didekatnya akan memperlihatkan
plak yang licin dan merah dengan permukaan yang mengalami maserasi. Pemeriksaan
harus dilakukan pada daerah-daerah, khususnya yang cenderung untuk mengalami
psoriasis, yaitu: siku, lutut, kulit kepala, celah gluteus, jari-jari tangan
dan kaki.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
Perawat harus menilai dampak penyakit tersebut pada
pasien dan strategi koping ynag digunakan untuk melaksanakan aktifitas sehari-hari
serta interaksi antara anggota keluarga dan teman-teman. Banyak pasien perlu
ditentramkan kekawatirannya dengan penjelasan bahwa penyakitnya tidak menular,
bukan mencerminkan higiene perorangan yang buruk dan juga bukan kanker kulit .</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l12 level1 lfo14; text-align: justify; text-indent: -18.0pt;">
<b>B.<span style="font: 7pt "Times New Roman";">
</span></b><b>Diagnosa Keperawatan</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l12 level2 lfo14; text-align: justify; text-indent: -18.0pt;">
1.<span style="font: 7pt "Times New Roman";">
</span>Gangguan integritas kulit berhubungan dengan adanya
lesi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l12 level2 lfo14; text-align: justify; text-indent: -18.0pt;">
2.<span style="font: 7pt "Times New Roman";">
</span>Gangguan body image berhubungan dengan adanya sisik
pada kulit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l12 level2 lfo14; text-align: justify; text-indent: -18.0pt;">
3.<span style="font: 7pt "Times New Roman";">
</span>Kurang pengetahuan terhadap penyakit, prognosis dan
kebutuhan pengobatan berhubungan dengan kurang pemajanan, kesalahan
interpretasi, kurang informasi<b>.</b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">
</span>
<br />
<div class="WordSection5">
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l12 level1 lfo14; text-align: justify; text-indent: -18.0pt;">
<b>C.<span style="font: 7pt "Times New Roman";">
</span></b><b>Intervensi Keperatan</b></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 23.4pt; width: 840px;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.0pt;" valign="top" width="36"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b>NO</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.85pt;" valign="top" width="174"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b>Diagnosa
Keperawatan</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.85pt;" valign="top" width="174"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b>Tujuan
& Kriteria Hasil</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 170.3pt;" valign="top" width="227"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b>Intervensi</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b>Rasional</b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.0pt;" valign="top" width="36"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
1.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.85pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: 150%;">
Gangguan integritas kulit
berhubungan dengan adanya lesi.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.85pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: 150%;">
Setelah dilakukan tindakan asuhan
keperawatan selama 1X24 jam, diharapkan tidak terjadi gangguan pada
integritas kulit. Dengan kriteria hasil:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l6 level1 lfo16; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span>Mempertahankan
integritas kulit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l6 level1 lfo16; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span>Tidak
ada lesi.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 170.3pt;" valign="top" width="227"><div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Kaji atau catat ukuran, warna, keadaan luka /
kondisi sekitar luka.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -6.85pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Lakukan kompres basah dan sejuk atau terapi
rendaman.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -6.85pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Lakukan perawatan luka dan hygiene sesudah itu
keringkan kulit dengan hati-hati dan taburi bedak yang tidak iritatif.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Berikan prioritas untuk meningkatkan kenyamanan
dan kehangatan pasien</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Gosokkan krim pelembab atau minyak secara
lembut.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228"><div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Memberikan informasi dasar tentang penanganan
kulit.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Merupakan tindakan protektif yang dapat
mengurangi nyeri.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -6.85pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Memungkinkan pasien lebih bebas bergerak dan
meningkatkan kenyamanan pasien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -6.85pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -6.85pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Mempercepat proses rehabilitasi pasien.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 11.15pt; mso-list: l11 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Untuk menghilangkan debriment.</div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.0pt;" valign="top" width="36"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
2.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.85pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: 150%;">
Gangguan body image berhubungan
dengan adanya sisik pada kulit.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.85pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: 150%;">
Setelah dilakukan tindakan asuhan
keperawatan selama 1X24 jam, diharapkan tidak terjadi gangguan body image.
Dengan kriteria hasil:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span>Menyatakan
penerimaan situasi diri.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span>Bicara
dengan keluarga/orang terdekat tentang situasi, perubahan yang terjadi.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 170.3pt;" valign="top" width="227"><div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Berikan kesempatan pada klien untuk
mengungkapkan perasaan tentang perubahan citra tubuh.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Nilai rasa keprihatinan dan ketakutan klien.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Bantu klien dalam mengembangkan kemampuan
untuk menilai diri dan mengenali serta mengatasi masalah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Mendukung upaya klien untuk memperbaiki citra
diri, mendorong sosialisasi dengan orang lain dan membantu klien ke arah
penerimaan diri.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -2.15pt; text-align: justify;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228"><div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Klien membutuhkan pengalaman didengarkan dan
dipahami dalam proses peningkatan kepercayaan diri.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -2.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Memberikan kesempatan kepada perawat untuk
menetralkan kecemasan dan memulihkan realitas situasi.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Kesan seseorang terhadap dirinya sangat
berpengaruh dalam pengembalian kepercayaan diri.</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Pendekatan dan saran yang positif dapat membantu
menguatkan usaha dan kepercayaan yang dilakukan.</div>
</td>
</tr>
<tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.0pt;" valign="top" width="36"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.85pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: 150%;">
Kurang pengetahuan terhadap
penyakit, prognosis dan kebutuhan pengobatan berhubungan dengan kurang
pemajanan, kesalahan interpretasi, kurang informasi<b>.</b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.85pt;" valign="top" width="174"><div class="MsoNormal" style="line-height: 150%;">
Setelah dilakukan tindakan
keperawatan selama 1x 24 jam di harapkan pasien dapat mengerti tentang
penyakit dan pengobatan yang berhubungan dengan penyakitnya.</div>
<div class="MsoNormal" style="line-height: 150%;">
Dengan kriteria hasil :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.55pt; mso-list: l13 level1 lfo19; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span>pasien
mengerti dan paham tentang kondisi, prognosis, dan pengobatan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.55pt; mso-list: l13 level1 lfo19; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span>pasien
dapat mengerti tentang tindakan pengobatan dan terapi </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.55pt; mso-list: l13 level1 lfo19; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";"> </span></span>melakukan
perubahan pola hidup tertentu dan berpartisipasi dalam program pengobatan.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 170.3pt;" valign="top" width="227"><div class="MsoNormal" style="line-height: 150%; margin-left: 15.55pt; mso-list: l13 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Kaji ulang prognosis dan harapan yang akan
datang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -2.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.55pt; mso-list: l13 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>diskusikan perawatan kulit contoh penggunaan
pelembab dan pelindung sinar matahari.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.55pt; mso-list: l13 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Dorong kesinambungan program latihan dan
jadwalkan periode istirahat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -2.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -2.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.55pt; mso-list: l13 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Kaji ulang pengobatan, termasuk tujuan, dosis,
rute, dan efek samping yang diharapkan dapat di laporkan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.55pt; mso-list: l13 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Berikan nomor telepon untuk orang yang di
hubungi.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228"><div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span> Memberikan dasar pengetahuan dimana pasien
dapat membuat pilihan berdasarkan informasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Gatal, lepuh, dan sensitifitas luka yang
sembuh .</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Mempertahankan
mobilitas, menurunkan komplikasi dan mencegah kelelahan, membantu
proses penyembuhan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Pengulangan memungkinkan kesempatan untuk
untuk bertanya dan menyakinkan pemahaman yanh akurat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -2.15pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 15.85pt; mso-list: l17 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings;">Ø<span style="font: 7pt "Times New Roman";">
</span></span>Memberikan akses yang mudah bagi tim
pengobatan untuk menguatkan pendidikan , klarifikasi kesalahan konsep, dan menurunkan potensial
komplikasi</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
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<div class="MsoNormal" style="line-height: 150%;">
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<b>DAFTAR
PUSTAKA</b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Doengoes, E, Marilynn. (2000). “<i>Rencana Asuhan
Keperawatan</i>”, Edisi 3, EGC: Jakarta.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.compas.com.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.dermatology.com.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.indomedia.com.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.medikaholistik.com.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.nuansamedia.com.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.psoriasis.or.id.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.republika.com.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.suarapembaruan.com.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Http/www.threeinone.cjb.net.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Price, Wilson. (1995). “<i>Patofisiologi</i>”, Edisi
4, EGC: Jakarta.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;">
Smeltzer, Suzanne. (2002). “<i>Buku Ajar Keperawatan
Medikal Bedah</i>”, Edisi 8, Volume 3, EGC: Jakarta.</div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-70771691337075377802011-11-10T07:39:00.001-08:002011-11-10T07:40:16.413-08:00Laparotomi<!--[if gte mso 9]><xml>
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<b style="mso-bidi-font-weight: normal;">LAPARATOMI</b></div>
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<b style="mso-bidi-font-weight: normal;">Pengertian</b></div>
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<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Midline incision</div>
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<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Paramedian, yaitu ; sedikit ke tepi dari garis tengah (<span style="font-family: Symbol; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">±</span></span> 2,5
cm), panjang (12,5 cm).</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Transverse upper abdomen incision, yaitu ; insisi di
bagian atas,misalnya pembedahan colesistotomy dan splenektomy.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Transverse lower abdomen incision, yaitu; insisi
melintang di bagian bawah <span style="font-family: Symbol; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">±</span></span> 4 cm di atas anterior spinal iliaka, misalnya; pada
operasi appendictomy.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Indikasi</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Trauma abdomen (tumpul atau tajam)</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Peritonitis</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Perdarahan saluran pencernaan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sumbatan pada usus halus dan usus besar.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Masa pada abdomen</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Komplikasi</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l14 level1 lfo4; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ventilasi paru tidak adekuat</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l14 level1 lfo4; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan kardiovaskuler : hipertensi, aritmia jantung.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l14 level1 lfo4; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan keseimbangan cairan dan elektrolit.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l14 level1 lfo4; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan rasa nyaman dan kecelakaan</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Latihan-latihan fisik</div>
<div class="MsoNormal">
Latihan napas dalam, latihan batuk, menggerakan otot-otot
kaki, menggerakkan otot-otot bokong, Latihan alih baring dan turun dari tempat
tidur. Semuanya dilakukan hari ke 2 post operasi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">POST<span style="mso-spacerun: yes;"> </span>LAPARATOMI</b></div>
<div class="MsoNormal">
Perawatan post laparatomi adalah bentuk pelayanan perawatan
yang diberikan kepada pasien-pasien yang telah menjalani operasi pembedahan
perut.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Tujuan perawatan post laparatomi;</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l3 level1 lfo5; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengurangi komplikasi akibat pembedahan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l3 level1 lfo5; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mempercepat penyembuhan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l3 level1 lfo5; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengembalikan fungsi pasien semaksimal mungkin seperti
sebelum operasi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l3 level1 lfo5; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mempertahankan konsep diri pasien.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l3 level1 lfo5; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mempersiapkan pasien pulang.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Komplikasi post laparatomi;</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo6; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan perfusi jaringan sehubungan dengan
tromboplebitis.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Tromboplebitis
postoperasi biasanya timbul 7 - 14 hari setelah operasi. Bahaya besar
tromboplebitis timbul bila darah tersebut lepas dari dinding pembuluh darah
vena dan ikut aliran darah sebagai emboli ke paru-paru, hati, dan otak.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Pencegahan
tromboplebitis yaitu latihan kaki post operasi, ambulatif dini dan kaos kaki
TED yang dipakai klien sebelum mencoba ambulatif.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo6; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Buruknya intergriats kulit sehubungan dengan luka
infeksi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Infeksi
luka sering muncul pada 36 - 46 jam setelah operasi. Organisme yang paling
sering menimbulkan infeksi adalah stapilokokus aurens, organisme; gram positif.
Stapilokokus mengakibatkan pernanahan. </div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Untuk
menghindari infeksi luka yang paling penting adalah perawatan luka dengan
memperhatikan aseptik dan antiseptik.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo6; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Buruknya integritas kulit sehubungan dengan dehisensi
luka atau eviserasi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Dehisensi
luka merupakan terbukanya tepi-tepi luka.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Eviserasi
luka adalah keluarnya organ-organ dalam melalui insisi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Faktor
penyebab dehisensi atau eviserasi adalah infeksi luka, kesalahan menutup waktu
pembedahan, ketegangan yang berat pada dinding abdomen sebagai akibat dari
batuk dan muntah.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Proses penyembuhan
luka</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Fase pertama</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Berlangsung
sampai hari ke 3. Batang lekosit banyak yang rusak / rapuh. Sel-sel darah baru
berkembang menjadi penyembuh dimana serabut-serabut bening digunakan sebagai
kerangka.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Fase kedua</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Dari
hari ke 3 sampai hari ke 14. Pengisian oleh kolagen, seluruh pinggiran sel
epitel timbul sempurna dalam 1 minggu. Jaringan baru tumbuh dengan kuat dan
kemerahan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Fase ketiga</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Sekitar
2 sampai 10 minggu. Kolagen terus-menerus ditimbun, timbul jaringan-jaringan
baru dan otot dapat digunakan kembali.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Fase keempat</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
Fase
terakhir. Penyembuhan akan menyusut dan mengkerut.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Intervensi untuk meningkatkan penyembuhan</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo7; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Meningkatkan intake makanan tinggi protein dan vitamin
c.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo7; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menghindari obat-obat anti radang seperti steroid.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo7; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pencegahan infeksi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Pengembalian Fungsi fisik.</div>
<div class="MsoNormal">
Pengembalian fungsi fisik dilakukan segera setelah operasi
dengan latihan napas dan batuk efektf, latihan mobilisasi dini.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Mempertahankan konsep diri.</div>
<div class="MsoNormal">
Gangguan konsep diri : Body image bisa terjadi pada pasien
post laparatomy karena adanya perubahan sehubungan dengan pembedahan.
Intervensi perawatan terutama ditujukan pada pemberian support psikologis, ajak
klien dan kerabat dekatnya berdiskusi tentang perubahan-perubahan yang terjadi
dan bagaimana perasaan pasien setelah operasi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Pengkajian</b></div>
<div class="MsoNormal">
Perlengkapan yang dilakukan pada pasien post laparatomy,
adalah;</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo8; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Respiratory</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bagaimana saluran pernapasan, jenis pernapasan,
bunyi pernapasan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo8; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sirkulasi</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tensi, nadi, respirasi, dan suhu, warna kulit,
dan refill kapiler.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo8; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Persarafan : Tingkat kesadaran.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo8; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Balutan </div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Apakah ada tube, drainage ?</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Apakah ada tanda-tanda infeksi?</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bagaimana penyembuhan luka ?</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo8; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Peralatan</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Monitor yang terpasang.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Cairan infus atau transfusi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo8; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span>Rasa nyaman</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Rasa sakit, mual, muntah, posisi pasien, dan
fasilitas ventilasi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo8; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span>Psikologis : Kecemasan, suasana hati setelah operasi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Diagnosa Keperawatan</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo9; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan rasa nyaman, abdomen tegang sehubungan dengan
adanya rasa nyeri di abdomen.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo9; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Potensial terjadinya infeksi sehubungan dengan adanya
sayatan / luka operasi laparatomi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo9; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Potensial kekurangan caiaran sehubungan dengan adanya
demam, pemasukkan sedikit dan pengeluaran cairan yang banyak.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Kriteria Evaluasi</b></div>
<div class="MsoNormal">
Hasil yang diharapkan setelah perawatan pasien post operasi,
meliputi;</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l11 level1 lfo10; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tidak timbul nyeri luka selama penyembuhan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l11 level1 lfo10; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Luka insisi normal tanpa infeksi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l11 level1 lfo10; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tidak timbul komplikasi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l11 level1 lfo10; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pola eliminasi lancar.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l11 level1 lfo10; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pasien tetap dalam tingkat optimal tanpa cacat.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l11 level1 lfo10; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kehilangan berat badan minimal atau tetap normal.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l11 level1 lfo10; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sebelum pulang, pasien mengetahui tentang :</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pengobatan lanjutan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Jenis obat yang diberikan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Diet.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Batas kegiatan dan rencana kegiatan di rumah.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">DAFTAR KEPUSTAKAAN</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Dr. Sutisna Himawan (editor). Kumpulan Kuliah Patologi. FKUI</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Brunner / Sudart. Texbook of Medical Surgical Nursing Fifth
edition IB. Lippincott Company. Philadelphia. 1984.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Soeparman, dkk. Ilmu Penyakit Dalam : Balai Penerbit FKUI,
Jakarta, 1987, Edisi II.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
PENATALAKSANAAN PERAWATAN</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Assesment</b></div>
<div class="MsoNormal">
Pengkajian ini meliputi obyektif dan subyektif.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo11; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data subyektif meliputi;</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri yang sangat pada daerah perut.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo11; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data obyektif meliputi :</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Napas dangkal</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tensi turun</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nadi lebih cepat</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Abdomen tegang</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Defense muskuler positif</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berkeringat</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bunyi usus hilang</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pekak hati hilang</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Diagnosa Keperawatan</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l2 level1 lfo12; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan rasa nyaman, abdomen tegang sehubungan dengan adanya
rasa nyeri di abdomen.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l2 level1 lfo12; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Potensial terjadinya infeksi sehubungan dengan adanya
sayatan / luka operasi laparatomi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l2 level1 lfo12; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Potensial kekurangan caiaran sehubungan dengan adanya
demam, pemasukkan sedikit dan pengeluaran cairan yang banyak.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Hasil yang diharapkan</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pasien akan tetap merasa nyaman.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pasien akan tetap mempertahankan kesterilan luka
operasinya.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pasien akan mempertahankan keseimbangan cairan dan
elektrolit.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Tindakan keperawatan
(intevensi keperawatan) pre operatif :</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pertahankan pasien untuk bedrest sampai diagnosa
benar-benar sudah ditegakkan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tidak memberikan apapun melaui mulut dan beritahukan
pasien untuk tidak makan dan minum.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitoring cairan intra vena bila diberikan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencatat intake dan output.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Posisi pasien seenak mungkin.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kolaborasi dengan dokter untuk pemberian obat-obatan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ajarkan pasien hal-hal yang perlu dilakukan setelah
operasi selesai.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitoring tanda-tanda vital.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Tindakan keperawatan
post operasi:</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo15; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitor kesadaran, tanda-tanda vital, CVP, intake dan
output</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo15; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Observasi dan catat sifat darai drain (warna, jumlah)
drainage.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo15; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Dalam mengatur dan menggerakan posisi pasien harus
hati-hati, jangan sampai drain tercabut.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo15; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Perawatan luka operasi secara steril.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Evaluasi</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo16; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tanda-tanda peritonitis menghilang yang meliputi :</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Suhu tubuh normal</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nada normal</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Perut tidak kembung</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Peristaltik usus normal</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Flatus positif</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bowel movement positif</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo16; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pasien terbebas dari rasa sakit dan dapat melakukan
aktifitas.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo16; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pasien terbebas dari adanya komplikasi post operasi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo16; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pasien dapat mempertahankan keseimbangan cairan dan
elektrolit dan mengembalikan pola makan dan minum seperti biasa.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo16; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Luka operasi baik.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">DAFTAR KEPUSTAKAAN</b></div>
<div class="MsoNormal">
Dr. Sutisna Himawan (editor). Kumpulan Kuliah Patologi. FKUI</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Brunner / Sudart. Texbook of Medical Surgical Nursing Fifth
edition IB. Lippincott Company. Philadelphia. 1984.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Soeparman, dkk. Ilmu Penyakit Dalam : Balai Penerbit FKUI,
Jakarta, 1987, Edisi II.</div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-1243502805573251172011-11-10T07:38:00.001-08:002011-11-10T07:40:16.469-08:00BATU EMPEDU<!--[if gte mso 9]><xml>
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<div class="WordSection1">
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Laporan
Pemdahuluan</span></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">ASUHAN
KEPERAWATAN PASIEN DENGAN CHOLELITHIASIS (BATU EMPEDU)</span></u></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"></span></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><br /></span></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l27 level1 lfo151; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pengertian : </span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l28 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batu saluran empedu : adanya
batu yang terdapat<span style="mso-spacerun: yes;"> </span>pada sal. empedu
(Duktus Koledocus ).</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l28 level1 lfo2; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batu Empedu(kolelitiasis) :
adanya batu yang terdapat pada kandung empedu.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l28 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Radang empedu (Kolesistitis)
: adanya radang pada kandung empedu.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l28 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Radang saluran empedu
(Kolangitis) : adanya radang pada saluran empedu.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l27 level1 lfo151; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Penyebab:</span></b></div>
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<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batu di dalam kandung
empedu. Sebagian besar batu tersusun dari pigmen-pigmen empedu dan kolesterol,
selain itu juga tersusun oleh bilirubin, kalsium dan protein.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Macam-macam batu yang
terbentuk antara lain:</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l17 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batu empedu kolesterol,
terjadi karena : kenaikan sekresi kolesterol dan penurunan produksi empedu. </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Faktor lain yang berperan dalam
pembentukan batu: </span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Infeksi kandung empedu</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Usia yang bertambah</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obesitas</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Wanita</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kurang makan sayur</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obat-obat untuk menurunkan kadar serum kolesterol</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">2.<span style="mso-spacerun: yes;"> </span>Batu pigmen empedu , ada dua macam;</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batu pigmen hitam : terbentuk di dalam kandung empedu dan disertai
hemolisis kronik/sirosis hati tanpa infeksi</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batu pigmen coklat<span style="mso-spacerun: yes;"> </span>:<span style="mso-spacerun: yes;"> </span>bentuk lebih besar , berlapis-lapis,
ditemukan disepanjang saluran empedu, disertai bendungan dan infeksi </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">3. Batu saluran empedu</span></div>
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<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sering dihubungkan dengan
divertikula duodenum didaerah vateri. Ada dugaan bahwa kelainan anatomi atau
pengisian divertikula oleh makanan akan menyebabkan obstruksi intermiten duktus
koledokus dan bendungan ini memudahkan timbulnya infeksi dan pembentukan batu.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l27 level1 lfo151; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">III.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pathofisiologi : </span></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batu empedu hampir selalu
dibentuk dalam kandung empedu dan jarang pada saluran empedu lainnya. </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Faktor predisposisi yang
penting adalah :</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Perubahan metabolisme yang disebabkan oleh perubahan susunan empedu</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Statis empedu</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Infeksi kandung empedu</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Perubahan susunan empedu
mungkin merupakan faktor yang paling penting<span style="mso-spacerun: yes;">
</span>pada pembentukan batu empedu. Kolesterol yang berlebihan akan mengendap
dalam kandung empedu .</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Stasis empedu dalam kandung
empedu dapat mengakibatkan supersaturasi<span style="mso-spacerun: yes;">
</span>progresif, perubahan susunan kimia dan pengendapan unsur tersebut.
Gangguan kontraksi kandung empedu dapat menyebabkan stasis. Faktor hormonal
khususnya selama kehamilan dapat dikaitkan dengan perlambatan pengosongan
kandung empedu dan merupakan insiden yang tinggi pada kelompok ini.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Infeksi bakteri dalam<span style="mso-spacerun: yes;"> </span>saluran empedu dapat memegang peranan
sebagian<span style="mso-spacerun: yes;"> </span>pada pembentukan batu dengan
meningkatkan deskuamasi seluler dan pembentukan mukus. Mukus meningkatkan
viskositas dan unsur seluler sebagai pusat presipitasi. Infeksi lebih sering
sebagai akibat pembentukan batu empedu dibanding infeksi yang menyebabkan
pembentukan batu.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l27 level1 lfo151; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">IV.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Perjalanan Batu</span></b></div>
<div class="MsoBodyTextIndent2">
Batu empedu asimtomatik dapat ditemukan secara
kebetulan pada pembentukan foto polos abdomen dengan maksud lain. Batu baru
akan memberikan keluhan bila bermigrasi ke leher kandung empedu (duktus
sistikus) atau ke duktus koledokus. Migrasi keduktus sistikus akan menyebabkan
obstruksi yang dapat menimbulkan iritasi zat kimia dan infeksi. Tergantung
beratnya efek yang timbul, akan memberikan gambaran klinis kolesistitis akut
atau kronik. </div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batu yang bermigrasi ke
duktus koledokus dapat lewat ke doudenum atau tetap tinggal diduktus yang dapat
menimbulkan ikterus obstruktif.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l27 level1 lfo151; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">V.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Gejala Klinis</span></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Penderita batu saluran
empedu sering mempunyai gejala-gejala kronis dan akut.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<br /></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 18.0pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-layout-alt: fixed;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="background: #F2F2F2; border-bottom: none; border: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; mso-pattern: gray-5 auto; mso-shading: windowtext; padding: 0cm 5.4pt 0cm 5.4pt; width: 230.4pt;" valign="top" width="307">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">GEJALA AKUT</span></div>
</td>
<td style="background: #F2F2F2; border-bottom: none; border-left: none; border-right: solid windowtext 1.0pt; border-top: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; mso-pattern: gray-5 auto; mso-shading: windowtext; padding: 0cm 5.4pt 0cm 5.4pt; width: 247.5pt;" valign="top" width="330">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">GEJALA KRONIS</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-bottom: none; border-left: solid windowtext 1.0pt; border-right: none; border-top: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 230.4pt;" valign="top" width="307">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">TANDA :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l23 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Epigastrium kanan terasa nyeri dan spasme</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l23 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Usaha inspirasi dalam waktu diraba pada kwadran kanan atas </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l23 level1 lfo9; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kandung empedu membesar<span style="mso-spacerun: yes;"> </span>dan
nyeri</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l23 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Ikterus ringan</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
<td style="border-bottom: none; border: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 247.5pt;" valign="top" width="330">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">TANDA:</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l2 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Biasanya tak tampak gambaran pada abdomen</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l2 level1 lfo12; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kadang terdapat nyeri di kwadran kanan atas</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2; mso-yfti-lastrow: yes;">
<td style="border-right: none; border: solid windowtext 1.0pt; mso-border-bottom-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 230.4pt;" valign="top" width="307">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">GEJALA:</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l14 level1 lfo13; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Rasa nyeri (kolik empedu) yang</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Menetap</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l14 level1 lfo14; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Mual dan muntah<span style="mso-spacerun: yes;">
</span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l14 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Febris (38,5</span><span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-size: 10.0pt; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">°<span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">°</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">C) </span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 247.5pt;" valign="top" width="330">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">GEJALA:</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l22 level1 lfo16; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Rasa nyeri (kolik empedu), Tempat : abdomen bagian atas (mid
epigastrium), Sifat : terpusat di epigastrium menyebar ke arah skapula kanan</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l22 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Nausea dan muntah</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l22 level1 lfo18; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Intoleransi dengan makanan berlemak</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l22 level1 lfo19; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Flatulensi</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l22 level1 lfo20; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Eruktasi (bersendawa)</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l27 level1 lfo151; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">VI.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pemeriksaan penunjang</span></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Tes laboratorium : </span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l21 level1 lfo21; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Leukosit : 12.000 - 15.000
/iu (N : 5000 - 10.000 iu). </span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l21 level1 lfo22; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Bilirubin : meningkat
ringan, (N : < 0,4 mg/dl). </span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l21 level1 lfo23; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Amilase serum meningkat.( N:
17 - 115 unit/100ml).</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l21 level1 lfo24; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Protrombin menurun, bila
aliran dari empedu intestin menurun karena obstruksi<span style="mso-spacerun: yes;"> </span>sehingga menyebabkan penurunan absorbsi
vitamin<span style="mso-spacerun: yes;"> </span>K.(cara Kapilar : 2 - 6 mnt).</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l21 level1 lfo25; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">USG : menunjukkan adanya
bendungan /hambatan , hal ini karena adanya batu empedu dan distensi saluran
empedu<span style="mso-spacerun: yes;"> </span>( frekuensi sesuai dengan
prosedur diagnostik)</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l21 level1 lfo26; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Endoscopic Retrograde
choledocho pancreaticography (ERCP), bertujuan untuk melihat kandung empedu,
tiga cabang saluran empedu melalui ductus duodenum.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l21 level1 lfo27; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">PTC (perkutaneus
transhepatik cholengiografi): Pemberian cairan kontras untuk menentukan adanya
batu dan cairan pankreas.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l21 level1 lfo28; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Cholecystogram (untuk
Cholesistitis kronik) : menunjukkan adanya batu di sistim billiar.</span></div>
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<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">CT Scan : menunjukkan
gellbalder pada cysti, dilatasi pada saluran empedu, obstruksi/obstruksi
joundice.</span></div>
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<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Foto Abdomen :Gambaran
radiopaque (perkapuran ) galstones, pengapuran pada saluran atau pembesaran
pada gallblader.</span></div>
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<br /></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Daftar Pustaka : </span></b><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo48; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Soeparman, Ilmu Penyakit
Dalam, Jilid II, Balai Penerbit FKUI 1990, Jakarta, P: 586-588.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo49; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sylvia Anderson Price,
Patofisiologi Konsep Klinis Proses-Proses Penyakit. Alih Bahasa AdiDharma,
Edisi II.P: 329-330.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo50; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Marllyn E. Doengoes, Nursing
Care Plan, Fa. Davis Company, Philadelpia, 1993.P: 523-536.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">D.D.Ignatavicius dan
M.V.Bayne, Medical Surgical Nursing, A Nursing Process Approach, W. B. Saunders
Company, Philadelpia, 1991.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo52; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sutrisna Himawan, 1994,
Pathologi (kumpulan kuliah), FKUI, Jakarta 250 - 251.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo53; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Mackenna & R. Kallander,
1990, Illustrated Physiologi, fifth edition, Churchill Livingstone, Melborne :
74 - 76.</span></div>
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<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l27 level1 lfo151; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">VII.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pengkajian</span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l19 level1 lfo30; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Aktivitas dan istirahat: </span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">subyektif : kelemahan</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obyektif<span style="mso-spacerun: yes;"> </span>: kelelahan</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l19 level1 lfo31; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sirkulasi :</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obyektif : Takikardia, Diaphoresis</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l19 level1 lfo32; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Eliminasi : </span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Subektif : Perubahan pada warna urine dan feces </span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obyektif : Distensi abdomen, teraba massa di abdomen atas/quadran kanan
atas, urine pekat . </span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l19 level1 lfo33; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Makan / minum (cairan)</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Subyektif
: Anoreksia, Nausea/vomit.</span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Tidak ada toleransi makanan lunak dan mengandung gas.</span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Regurgitasi ulang, eruption, flatunasi.</span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Rasa seperti terbakar pada epigastrik (heart burn).</span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Ada peristaltik, kembung dan dyspepsia.</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obyektif
: </span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kegemukan.</span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kehilangan berat badan (kurus).</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l19 level1 lfo34; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Nyeri/ Kenyamanan :</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Subyektif
:</span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Nyeri abdomen menjalar<span style="mso-spacerun: yes;"> </span>ke
punggung sampai ke bahu.</span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Nyeri apigastrium setelah makan.</span></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Nyeri tiba-tiba dan mencapai puncak setelah 30 menit.</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obyektif
:</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Cenderung
teraba lembut pada klelitiasis, teraba otot meregang /kaku hal ini dilakukan
pada pemeriksaan RUQ dan menunjukan tanda marfin (+).</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l19 level1 lfo35; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Respirasi :</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obyektif
: Pernafasan panjang, pernafasan pendek, nafas dangkal, rasa tak nyaman.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l19 level1 lfo36; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Keamanan :</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obyektif
: demam menggigil, Jundice, kulit kering dan pruritus , cenderung perdarahan (
defisiensi Vit K ).</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l19 level1 lfo37; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Belajar mengajar :</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Obyektif : Pada keluarga
juga pada kehamilan cenderung mengalami batu kandung empedu. Juga pada riwayat
DM dan gangguan / peradangan pada saluran cerna bagian bawah.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Prioritas Perawatan :</span></b></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l1 level1 lfo38; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Meningkatkan fungsi
pernafasan.</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l1 level1 lfo39; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Mencegah komplikasi.</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l1 level1 lfo40; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Memberi
informasi/pengetahuan tentang penyakit, prosedur, prognosa dan pengobatan</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Tujuan Asuhan Perawatan :</span></b></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l6 level1 lfo41; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Ventilasi/oksigenasi yang
adekwat.</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l6 level1 lfo42; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Mencegah/mengurangi
komplikasi.</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l6 level1 lfo43; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Mengerti tentang proses
penyakit, prosedur pembedahan, prognosis dan pengobatan </span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Diagnosa Perawatan:</span></b></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l25 level1 lfo44; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pola nafas tidak efektif
sehubungan dengan nyeri, kerusakan otot, kelemahan/ kelelahan, ditandai dengan
: </span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Takipneu</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Perubahan pernafasan </span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Penurunan vital kapasitas.</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pernafasan tambahan</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Batuk terus menerus</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l25 level1 lfo45; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Potensial Kekurangan cairan
sehubungan dengan :</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kehilangan cairan dari nasogastrik.</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Muntah.</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pembatasan intake </span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Gangguan koagulasi, contoh : protrombon menurun, waktu beku lama.</span></div>
<div align="center" class="MsoNormal" style="margin-left: 126.0pt; mso-list: skip; text-align: center; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l25 level1 lfo46; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Penurunan integritas
kulit/jaringan sehubungan dengan<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pemasanagan drainase T Tube.</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Perubahan metabolisme.</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pengaruh bahan kimia (empedu)</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>ditandai dengan :</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">adanya gangguan kulit.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l25 level1 lfo47; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kurangnya pengetahuan tentang
prognosa dan kebutuhan pengobatan, sehubugan dengan : </span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Menanyakan kembali tentang imformasi.</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Mis Interpretasi imformasi.</span></div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Belum/tidak kenal dengan sumber imformasi.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>ditandai :<span style="mso-spacerun: yes;"> </span>. pernyataan yang salah.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>. permintaan
terhadap informasi.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>. Tidak mengikuti
instruksi.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Daftar Pustaka : </span></b><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"></span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l9 level1 lfo48; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Soeparman, Ilmu Penyakit
Dalam, Jilid II, Balai Penerbit FKUI 1990, Jakarta, P: 586-588.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l9 level1 lfo49; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sylvia Anderson Price,
Patofisiologi Konsep Klinis Proses-Proses Penyakit. Alih Bahasa AdiDharma,
Edisi II.P: 329-330.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l9 level1 lfo50; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Marllyn E. Doengoes, Nursing
Care Plan, Fa. Davis Company, Philadelpia, 1993.P: 523-536.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l9 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">D.D.Ignatavicius dan
M.V.Bayne, Medical Surgical Nursing, A Nursing Process Approach, W. B. Saunders
Company, Philadelpia, 1991.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l9 level1 lfo52; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">11.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sutrisna Himawan, 1994,
Pathologi (kumpulan kuliah), FKUI, Jakarta 250 - 251.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l9 level1 lfo53; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Mackenna & R. Kallander,
1990, Illustrated Physiologi, fifth edition, Churchill Livingstone, Melborne :
74 - 76.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Asuhan
keperawatan :</span></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Indentitas klien : </span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Nama :Tuan IL , 38 tahun, laki-laki.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Alamat : Jalan Makmur, Bekasi.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Status : Kawin.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Agama : Islam</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pendidikan : SMP</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pekerjaan : Pedagang.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Suber informasi : Klien dan istri.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Tanggal masuk RS : 29 April 1998.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Diagnosa Masuk : Kolangitis, Kolesistitis, Kolelitiasis.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo55; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Status Kesehatan saat ini :</span></div>
<div class="MsoBodyTextIndent">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Alasan kunjungan/ keluhan utama : 1 bulan sebelum masuk RS. Klien
merasa nyeri perut kanan atas, nyeri tidak menjalar, nyeri bila menarik nafas,
nyeri seperti ditusuk. Panas naik turun hingga menggigil, bila nyeri klien
menjadi sesak. selama di rumah diberikan obat promag keluhan hilang tetapi
hanya sementara. sehari sebelum masuk RS dirasa nyeri timbul lagi shg klien.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo56; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">III.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Riwayat Kesehatan yang lalu
: Pada usia 12 tahun klien pernah bengkak diseluruh tubuh dan tidak pernah
berobat, sembuh sendiri. belum pernah operasi dan dirawat di RS, tak ada alergi
terhadap makanan dan obat-obatan , Klien merokok 1/2 bungkus per hari dan minum
kopi 2x sehari. Kien terbiasa minum obat sendiri bila sakit tak pernah berobat
ke dokter atau ke puskesmas . Frehuensi makan 3x sehari , berat badan waktu
masuk ke RS 50 kg. makanan yang disukai supermi, Tak ada makanan yang<span style="mso-spacerun: yes;"> </span>pantangan. sedangkan makanan yang tidak
disukai adalah gorengan dan makanan yang mengandung santan. nafsu makan baik.
Frekuensi bab 1 x sehari konsistensi padat, sedangkan kencing rata-rata 6 x
sehari, tak ada keluhan dalam eliminasi. klien tidak terjadwal dalam memenuhi
pola istirahat dan tidur, kadang-kadang sampai pk. 23.00 Kegiatan waktu luang
membuat meja dan kursi. Klien hidup bersama seorang istri dan 4 orang anaknya,
2 orang laki-laki dan 2 orang perempuan.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo57; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">IV.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Riwayat lingkungan </span></div>
<div class="MsoBodyTextIndent">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kebersihan,lingkungan cukup, kondisi rumah luas, dengan enam kamar,
tinggal dirumah dengan lingkungan yang ramai (padat bukan karena polusi atau
kendaraan bermotor).</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo58; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">V.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Aspek PsikoSosial : </span></div>
<div class="MsoBodyTextIndent">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pola pikir sangat sederhana karena ketidaktahuan informasi dan
mempercayakan sepenuhnya dengan rumah sakit. Klien pasrah terhadap tindakan
yang dilakukan oleh rumah sakit asal cepat sembuh.<span style="mso-spacerun: yes;"> </span>Persepsi diri baik, klien merasa nyaman,
nyeri tidak timbul sehubungan telah dilakukan tindakan cholesistektomi.
Hubungan klien dan perawat baik, akomodatif, dengan bahasa indonesia yang cukup
baik. Klien tidak mengeluh tentang biaya pengobatan/perawatan karena klien
sudah menyiapkan sebelum masuk rumah sakit. Klien beragama Islam, sholat lima
wakt, hanya kadang-kadang ia lakukan.<span style="mso-spacerun: yes;">
</span>Dirumah sakit klien tidak sholat karena menurutnya ia sakit.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pengkajian
Fisik : </span></b></div>
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<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Aktivitas/istirahat:</span></div>
<div class="MsoBodyTextIndent">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Klien merasakan lemah, mobilisasi duduk, merasa sakit pada lokasi drain
bila posisi berubah dari berbaring ke duduk. Sore tidur 2 jam, malam tidur
mulai jam 10.00. Kadang-kadang terganggu oleh keramaian pasien lain.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l20 level1 lfo60; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sirkulasi :</span></div>
<div class="MsoBodyTextIndent">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sinus normokardia, suhu subfebris 37,5<span style="mso-spacerun: yes;">
</span>c , Denyut nadi :90 kali permenit.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l20 level1 lfo61; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Eliminasi </span></div>
<div class="MsoBodyTextIndent">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Klien bab 1 kali sehari, konsistensi lembek, warna kuning, jumlah urine
1500 cc/24 jam.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l20 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Makan/minum ( cairan )</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sering regurgitasi, keluar cairan kurang lebih 200 cc/24 jam</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Diet cair (DH I) dihabiskan , 1200 kalori dalam 900 cc /24 jam</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Minum air putih 1500 cc/24 jam</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Peristaltik normal<span style="mso-spacerun: yes;"> </span>(20 30
kali/menit)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Selama tujuh hari<span style="mso-spacerun: yes;"> </span>intake scara
parenteral , yaitu amilase dan RD </span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">tidak kembung</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Klien tampak kurus<span style="mso-spacerun: yes;"> </span>(BB: 47,7Kg)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l20 level1 lfo63; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Nyeri/Kenyamanan </span></div>
<div class="MsoBodyTextIndent">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Tidak timbul rasa nyeri, hanya kadang-adang sakit, pada waktu perubahan
posisi dari baring ke duduk.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l20 level1 lfo64; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Respirasi :</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Respirasi normal : 20 kali /menit</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Klien merasa nyaman bernafas bila duduk.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l20 level1 lfo65; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Keamanan :</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Suhu klien 37,5 C (subfebris)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Sklera tampak icterik, kulit agak kering </span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Tampak plebitis (kemerahan) pada bekas infus dilengan kiri dan kanan</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l20 level1 lfo66; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Klien telah dilakukan
operasi Cholecistektomi tanggal 30 April 1998. Sekarang ia mengalami perawatan
hari ke delapan . Terpasang drainase T. Tube, produksi cairan hijau pekat
500cc/24 jam</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pemeriksaan
Penunjang </span></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l13 level1 lfo67; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pemeriksaan laboratorium
tanggal 29 April 1998 :</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">H B . 10,7<span style="mso-spacerun: yes;"> </span>(13-16)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Hematokrit : 31<span style="mso-spacerun: yes;"> </span>( 40 - 48 )</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Leukosit<span style="mso-spacerun: yes;"> </span>: 154.00<span style="mso-spacerun: yes;"> </span>( 50,00 - 100,00)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Trombosit : 328,00<span style="mso-spacerun: yes;"> </span>( 200.00 -
500.00)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Bilirubin Direck<span style="mso-spacerun: yes;"> </span>: 6,1<span style="mso-spacerun: yes;"> </span>( <!--= 0,4)</span--></span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Bilirubin Indireck : 1,8<span style="mso-spacerun: yes;"> </span>(<!--=
0,6)</span--></span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Bilirubin total<span style="mso-spacerun: yes;"> </span>:7,9<span style="mso-spacerun: yes;"> </span>(0,3<span style="mso-spacerun: yes;">
</span>-<span style="mso-spacerun: yes;"> </span>1,0)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Protein total<span style="mso-spacerun: yes;"> </span>: 5,7<span style="mso-spacerun: yes;"> </span>( 6 - 7,8 )</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Albumin<span style="mso-spacerun: yes;"> </span>:2,7<span style="mso-spacerun: yes;"> </span>( 4 - 5,2)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Globulin<span style="mso-spacerun: yes;"> </span>: 3,0<span style="mso-spacerun: yes;"> </span>(1,3 - 2,7 )</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Amilase<span style="mso-spacerun: yes;"> </span>darah :108<span style="mso-spacerun: yes;"> </span>(17 - 115)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">SGOT<span style="mso-spacerun: yes;"> </span>: 70<span style="mso-spacerun: yes;"> </span>( < 37), SGPT<span style="mso-spacerun: yes;"> </span>: 58<span style="mso-spacerun: yes;">
</span>(< 41 )</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Natrium darah<span style="mso-spacerun: yes;"> </span>:132<span style="mso-spacerun: yes;"> </span>(135 - 147) </span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">kalium darah<span style="mso-spacerun: yes;"> </span>:3,2<span style="mso-spacerun: yes;"> </span>(3,5 - 5,5 ) </span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Klorida darah<span style="mso-spacerun: yes;"> </span>: 105<span style="mso-spacerun: yes;"> </span>(100 - 106)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l13 level1 lfo68; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pemeriksaan Diagnostik lain:</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Ultrasonografi tanggal: 24 April l998</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kesan:Batu pada CBD yang
menyebabkan<span style="mso-spacerun: yes;"> </span>obstruksi</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Cholesistitis</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Cholesistografi tanggal 29 April 1998</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Hasil : Tampak selang T-tube setinggi
Thoracal XII kanan</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">3.<span style="mso-spacerun: yes;"> </span>Elektro
kardiografi tanggal: 28 April 1998</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Hasil :
SR, QRS rate 60/menit</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;">
</span>ST, T Changes negatif</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">4.<span style="mso-spacerun: yes;">
</span>Cholesistektomy, 29 April 1996 :</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">keluar pus 10 cc, di kultur belum ada hasil</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">ekstrasi batu, keluar batu besar dan kecil dan lumpur.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">dipasang T-tube dan CBD<span style="mso-spacerun: yes;"> </span>(Commond
Bile Duct)</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Pengobatan :</span></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">2 x 1 gr Cefobid (IV)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">1 x 2 cc Vit B Comp (IM)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">1 x 200 mg Vit. C (IV)</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Persepsi klien
terhadap penyakitnya :</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Klien merasa optimis untuk sembuh dengan upaya
pembedahan dan saat ini tidak merasakan sakit atau nyeri seperti sebelum
operasi. </span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kesan perawat
terhadap klien :</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Klien koperatif dan komunikatif, dan mempunyai
motivasi untuk sembuh</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kesimpulan :</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Dari data yang didapatkan dapat disimpulkan masalah
yang ada saat ini adalah:</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l26 level1 lfo69; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Potensial gangguan
keseimbangan cairan </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l26 level1 lfo70; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Gangguan integritas kulit </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l26 level1 lfo71; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 12.0pt; mso-bidi-font-size: 10.0pt;">Kurangnya pengetahuan
tentang penyakit prognosis dan program pengobatan</span><span style="font-size: 14.0pt; mso-bidi-font-size: 10.0pt;"></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<div class="WordSection2">
<div class="MsoNormal" style="text-align: justify;">
NAMA KLIEN<span style="mso-spacerun: yes;"> </span>:<span style="mso-tab-count: 4;"> </span><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">ASUHAN KEPERAWATAN<span style="mso-spacerun: yes;"> </span></b></div>
<div class="MsoNormal">
BANGSAL/TEMPAT:<span style="mso-spacerun: yes;">
</span><span style="mso-tab-count: 9;"> </span><span style="mso-tab-count: 3;"> </span>MATA
AJARAN :<span style="mso-spacerun: yes;"> </span>KMB</div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .75pt; mso-border-insideh: .75pt solid windowtext; mso-border-insidev: .75pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-layout-alt: fixed;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border-bottom: none; border: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.4pt;" valign="top" width="31">
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">No</b></div>
</td>
<td style="border-bottom: none; border-left: none; border-right: solid windowtext 1.0pt; border-top: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162">
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">DIAGNOSA PERAWATAN</b></div>
</td>
<td style="border-bottom: none; border-left: none; border-right: solid windowtext 1.0pt; border-top: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162">
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">TUJUAN</b></div>
</td>
<td style="border-bottom: none; border-left: none; border-right: solid windowtext 1.0pt; border-top: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.5pt;" valign="top" width="210">
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-bottom: none; border-left: none; border-right: solid windowtext 1.0pt; border-top: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
<td style="border-bottom: none; border-left: none; border-right: solid windowtext 1.0pt; border-top: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.5pt;" valign="top" width="198">
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">IMPLEMENTASI</b></div>
</td>
<td style="border-bottom: none; border-left: none; border-right: solid windowtext 1.0pt; border-top: solid windowtext 1.0pt; mso-border-left-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-right-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.5pt;" valign="top" width="198">
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">EVALUASI</b></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.4pt;" valign="top" width="31">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";"><span style="mso-spacerun: yes;"> </span>1.</span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Potensial
gangguan keseimbangan cairan sehubungan dengan :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Kehilangan
cairan dr nasogatric.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Muntah<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Gangguan
koagulasi darah : protrombin menurun, waktu beku lama.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<u><span style="font-family: "Century Gothic","sans-serif";">Data Subyektif</span></u><span style="font-family: "Century Gothic","sans-serif";"> :</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<u><span style="font-family: "Century Gothic","sans-serif";">Data Obyektif</span></u><span style="font-family: "Century Gothic","sans-serif";"> :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Muntah
200 cc</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Diit
cair : DiitHepar I 900 cc</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Plebitis
positf bekas infus pada tangan kiri.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">T-tube
: keluar cairan 200 cc, warna hijau keruh</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Suhu
37,5<span style="mso-spacerun: yes;"> </span>C</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Turgor
kulit sedikit menurun </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mukosa
mulut baik</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Hb
: 10,7 gr%</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Ht<span style="mso-spacerun: yes;"> </span>: 31 gr/dl</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Natrium
: 132 meq/L </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Kalium
: 3,2 meq/L</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Chlorida
: 105 meq/L</span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Menunjukkan
keseimbangan cairan yg adekuat, ditandai dengan :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Selaput
membran yg lembab.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Turgor
kulit baik.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Urine
normal 1500 cc/24 jam<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Out
put normal, tdk ada muntah.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.5pt;" valign="top" width="210">
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo72; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Monitor
intake & output,<span style="mso-spacerun: yes;"> </span>drainase dari
T-tube, dan luka operasi. Timbang BB secara periodik<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo73; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Monitor
tanda vital,<span style="mso-spacerun: yes;"> </span>kaji mukosa membran,
tur-gor kulit, nadi perifer.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo74; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Observasi
tanda perda-rahan contoh: hemate-mesis, ptekie, ekimosis </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo75; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Gunakan
jarum injeksi yang kecil dan tekan bekas tusukan<span style="mso-spacerun: yes;"> </span>dalam waktu yang lama</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo76; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Gunakan
sikat gigi yang lembut</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<u><span style="font-family: "Century Gothic","sans-serif";">KOLABORASIi
:</span></u><span style="font-family: "Century Gothic","sans-serif";"></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo77; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Monitor
hasil pemeri-ksaan Hb, elektrolit, pro-trombin, Cloting time dan bleeding
time<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo78; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Berikan
cairan intra-vena, produksi darah sesuai dengan indikasi </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo79; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Berikan
cairan elektrolit</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l16 level1 lfo80; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Beri
Vitamin K (IV)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo81; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Memberikan
imformasi ttg kebutuhan & fungsi organ tubuh. Khususnya cairan empedu
yang keluar 200 - 500 ml, penurunan cairan empedu yang masuk ke
intestine.<span style="mso-spacerun: yes;"> </span>Keluarnya cairan empedu
terus menerus dalam jumlah yg banyak, menandakan adanya ob-struksi, kadang -
kadang adanya fistula pd empedu. Indikasi yg adekuat pada volume sirkulasi
/perfusi.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo82; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Protrombin
menurun dan terjadi waktu pembekuan lama ketika adanya ob struksi saluran
empedu. Meningkat pada resiko perdarahan.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo83; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mengurangi
trauma, resiko perdarahan / hematom</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo84; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menghindari
trauma dan perdarahan gusi</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo85; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Memberikan
informasi volu me sirkulasi , keseimbangan elektrolit dan faktor pem bekuan
darah</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo86; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mempertahankan
volume sirkulasi yang adekuat dan mengembalikan faktor pembekuan yang adekuat</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo87; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mengoreksi
hasil dari ketidak seimbangan dari pengeluaran gastrik dan luka</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo88; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">volume
sirkulasi & mem-perbaiki ketidak seimba-ngan.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l12 level1 lfo89; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Meningkatkan
atau mem- percepat proses pem- bekuan.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.5pt;" valign="top" width="198">
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo90; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Memonitor
dan mencatat intake cairan atau minum ,output dari T-tube, perda rahan luka
operasi dan urine.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo91; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mengobservasi
tanda vital Tekanan darah, denyut nadi, suhu, dan respirasi, turgor dan
mukosa mem-bran.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo92; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Melakukan
observasi ada nya perdarahan pd daerah luka operasi, ple-bitis / hematom pada
bekas pemasangan infus di lengan. </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo93; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Memberikan
suntikan dgn jarum kecil<span style="mso-spacerun: yes;"> </span>dan menekan
bekas tusukan kurang lebih 5 menit.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo94; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menganjurkan
klien untuk menggosok gigi dengan sikat gigi yang lembut</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo95; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Melakukan
pemganbilan darah untuk pemeriksaan : albmin, globulin, Hb, Ht, Lekosit,
trombosit, Na,K, Cl.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo96; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Infus
amilase dan RD telah dilepas satu hari yang lalu (30 April 1996)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo97; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Tidak
diberikan karena tidak ada indikasi</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo98; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Tidak
diberikan karena klien tidak dapat terapi tersebut<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.5pt;" valign="top" width="198">
<div class="MsoNormal" style="text-align: justify;">
<u><span style="font-family: "Century Gothic","sans-serif";">Tgl 1 Mei 1996</span></u><span style="font-family: "Century Gothic","sans-serif";"></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Gothic","sans-serif";">S :</span></b><span style="font-family: "Century Gothic","sans-serif";"> Klien masih me rasa mual ,
sang- gup mengosok gigi dan berkumur.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Gothic","sans-serif";">O :</span></b><span style="font-family: "Century Gothic","sans-serif";"> Klien muntah<span style="mso-spacerun: yes;"> </span>50 cc . Turgor kulit membaik, Intake :2500
cc, output 1500 cc, IWL 600 cc, T-tube 200 cc,Balance cairan -200 cc. TD:
120/80 mmHg, Nadi : 88x/menit, Suhu: 37.5 C, RR : 20x/menit,<span style="mso-spacerun: yes;"> </span>ple bitis pada tangan kiri bekas pengam
bilan darah dan infus</span></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Gothic","sans-serif";">A:</span></b><span style="font-family: "Century Gothic","sans-serif";"> Klien masih me merlukan
penga wasan dalam ke seimbangan cai ran</span></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Gothic","sans-serif";">P:</span></b><span style="font-family: "Century Gothic","sans-serif";"> Intervensi tetap
diteruskan sambil observasi intake dan out put dan tanda-tanda vital. Sambil
menunggu hasil laboratorium yang lain.</span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.4pt;" valign="top" width="31">
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">2.</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162">
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Penurunan
integritas kulit atau jaringan sehubu ngan dengan :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Pemasangan
drai-<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>nase
(T-tube)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Perubahan
metabo-lisme.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Pengaruh
bahan kimia (empedu)</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Ditandai
adanya gang-guan kulit :</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Data
Subyektif :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Klien
mengatakan : Kapan selang saya dicabut dan lukanya dapat capat sembuh karena
ingin mandi bebas selama ini hanya dilap dgn whaslap.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Banyak
berkeringat & membuat badan tdk enak & gatal-gatal.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Posisi
tidur tdk enak krn ada luka operasi & selang.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Matanya
masih kuning tapi sudah berkurang dr sebelumnya.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Data
Obyektif :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Masih
terpasang T-tube difiksasi ke tempat tidur.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Jumlah
cairan empe du yg keluar 200cc.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Badan
masih ikterus terutama sklera mata.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Posisi
tidur/ istirahat semifowler dan ber sandar di tempat tidur diganjal dgn
bantal.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Luka
Operasi tdk tampak tanda-tan da infeksi.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Terapi
2 x 1gram Ce fobit (IV).</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Lab
Hasil bilirubin tgl 30-4-96. meningkat.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Klien
imobolisasi su dah 7 hari</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162">
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Adanya
pemulihan lu- ka tanpa komplikasi</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Kriteria:</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Perilaku
yg meningkat terhadap pemulihan luka</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.5pt;" valign="top" width="210">
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l11 level1 lfo99; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Cek
T-tube dan luka insisi, upayakan agar aliran bebas/lancar .</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Observasi
warna dan sifat drainase. Gunakan ostotomi bag yang disposible</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Pertahankan
posisi selang drainase tube di tempat tidur</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Atur
posisi<span style="mso-spacerun: yes;"> </span>semi fowler</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Observasi
sedakan,<span style="mso-spacerun: yes;"> </span>distensi abdomen,
peritonitis dan pankreatitis</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Ganti
pakaian klien, higiene kulit, disekitar luka insisi.</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Observasi
perubahan warna kulit sclera dan urin</span></div>
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<span style="font-family: "Century Gothic","sans-serif";">KOLABORASI
:</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Beri
antibiotik sesuai indikasi.</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">lakukan
penghentian T tube secara berkala mencoba slang saluran empedu sebelum
di-angkat</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Siapkan
pembedahan bila diperlukan.</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Monitor
hasil lab: Contoh : Leukosit</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Pemasangan
T-tube di CBD selama 7 - 10 hari untuk mengeluarkan sisa-sisa batu. Tempat
insisi untuk mengeluarkan sisa-sisa cairan pada empedu. Koreksi posisi untuk
mencegah cairan kembali ke empedu. </span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Drainase
berisi darah dan sisa darah, secara normal berubah warna hijau tua (warna
empedu) sesudah beberapa jam pertama. Ostotomi mungkin digunakan untuk
mengumpulkan cairan dan melindungi kulit </span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mempertahankan
lepasnya selang atau pembentukan lumen</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mempermudah
aliran em pedu</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Lepasnya
T-tube dapat menyebabkan iritasi dia fragma atau komplikasi yg serius jika
saluran empedu masuk ke dalam perut atau sumbatan pada salu ran pankreas</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menjaga
kebersihan kulit disekitar insisi dapat mening katkan perlindungan kulit ter
hadap ulserasi.</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Perkembangan
ikterik dpt diindikasikan sebagai ob- struksi sal. empedu.</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Untuk
mengurangi infeksi atau abses</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Untuk
mengetes kemam- puan saluran CBD sebelum T tube diangkat. </span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Tindakan
insisi atau dra inase/fistulektomi dilakukan untuk mengobati abses atau
fistula.</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Peningkatan
leukosit seba</span></div>
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<span style="font-family: "Century Gothic","sans-serif";">gai
gambaran adanya proses imflamasi contoh abses atau terjadinya
peritonitis/pankeatitis.</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Dressing
luka insisi tiap pagi dan atur posisi drain agar tetap lancar</span></div>
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<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Melakukan
observasi war-na, jumlah cairan drainase.</span></div>
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<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo119; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mencek
posisi selang dan memfiksasi selang drainase ditempat tidur</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo120; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";"><span style="mso-spacerun: yes;"> </span>Mengatur klien posisi semi fowler dan posisi
duduk</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo121; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";"><span style="mso-spacerun: yes;"> </span>Mengobservasi adanya sedakan, distensi
abdomen, peritonitis dan pankreatitis </span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo122; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mengganti
pakaian tiap pagi dan sore, bersama istri klien membersihkan kulit dengan
sabun dan air.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l15 level1 lfo123; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Melakukan
observasi ter hadap kulit, sclera mata dan warna urin. </span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Memberikan
injeksi Cefobit<span style="mso-spacerun: yes;"> </span>1 gram (IV) jam 08.00
pagi.</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Melakukan
klem pada slang saluran empedu</span></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Tindakan
tidak dilakukan sebab tidak ada indikasi. </span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Melakukan
pengambilan untuk pemeriksaan peme riksaan leukosit.</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.5pt;" valign="top" width="198">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">tanggal
1`mei 96.</span></div>
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<span style="font-family: "Century Gothic","sans-serif";">S:
Kliem mengatakan masih merasa terganggu dgn adanya drain t-tube, sudah dpt
istirahat/tidur dgn posisi semofowler.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">O:
Mandi 2x sehari dibantu istri menggunakan sabun & sikat gigi yg lembut.
menggunakan bedak/powder utk tubuh, baju bersih & kering, dapat tidur
siang selama 2 jam dgn posisi semifowler, luka operasi/daerah pemasangan
drain tdk ada tanda infeksi & balutan dlm keadaan bersih & kering.
Lingkungan klien (tempat tidur) dalam keadaan bersih dan rapih. Injeksi
antibiotik 1 gram Cefobit sudah diberikan.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Hasil
lab. ulang belum ada.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">A:
Masalah penurunan integritas kulit masih ada.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">P
: Lanjutkan intervensi terutama pertahankan/tingkatkan personal higiene ,
tingkatkan mobilisasi/jalan sesuai kemampuan.</span></div>
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<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 23.4pt;" valign="top" width="31">
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">3.</span></div>
</td>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Kurang
pengetahuan tentang kondisi prog nosa dan kebutuhan pengobatan, sehubu ngan
dgn : menanya kan kembali ttg imfor masi, menanyakan kem bali informasi,
belum /tidak kenal dengan sumber imformasi ditan- dai :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Pernyataan
yang salah.</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Permintaan
thd im- formasi.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Tidak
mengikuti ins- truksi.</span></div>
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<u><span style="font-family: "Century Gothic","sans-serif";">Data
subyektif</span></u><span style="font-family: "Century Gothic","sans-serif";">
: </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">klien
menyatakan bahwa tdk mengerti ttg proses penyakit, prosedur pembe-dahan &
pengoba-tan karena tdk ada yg memberi tahu, dan dokter memberi tahu bahwa
saya harus operasii.</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162">
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Secara
verbal me ngerti akan proses penyakit, pengoba tan dan prognosis pembedahan.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Melakukan
koreksi thd prosedur yang penting & menjelaskan reaksi dr tindakan.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menilai
perubahan gaya hidup dan ikut serta dalam pengobatan</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 157.5pt;" valign="top" width="210">
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo124; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Kaji
ulang<span style="mso-spacerun: yes;"> </span>pada klien ttg pengetahuan<span style="mso-spacerun: yes;"> </span>pro- ses penyakit , prosedur pembedahan ,
prog- nosa.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo125; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Ajarkan
perawatan insisi atau membersihkan luka .</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo126; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Anjurkan
agar aliran T Tube dikumpul;kan dlm kantong dan catat pengeluarannya.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo127; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Pertahankan
diit rendah lemak selama </span><span style="font-family: Symbol; mso-ascii-font-family: "Century Gothic"; mso-char-type: symbol; mso-hansi-font-family: "Century Gothic"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">±</span></span><span style="font-family: "Century Gothic","sans-serif";">
4 - 6 bulan.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo128; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Hindari
alkohol,</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo129; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Anjurkan
klien utk men-catat dan menghindari makanan yg dpt me-nyebabkan deare.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo130; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Identifikasi
tanda/ gejala : urine keruh, warna kuning pada mata/kulit, warna feses.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo131; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Kaji
ulang keterbatsan aktifitas, tergantung situasi individu.</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo132; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">beri
pengetahuan dasar pada klien sehingga klien dapat memilih imformasi yang
dibutuhkan.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo133; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Akan
mengurangi ketergan ungan dalam perawatan, dan menurunkan resiko kom likasi.
(infeksi, obstruksi empedu)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo134; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menurunkan
resiko aliran balik pada slang T-tube. Memberi informasi ttg kembalinya edema
saluran/ fungsi saluran.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo135; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Selama
enam bulan setelah pembedahan<span style="mso-spacerun: yes;"> </span>bo-leh
sedikit diberikan rendah makanan rendah lemak utk memberikan rasa nyaman
karena ggn sistim pencernaan lemak. </span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo136; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Meminimalkan
resiko terja- dinya penkreatitis</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo137; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Pembatasan
diityang pasti mungkin dapat menolong misalnya dgn diit rendah lemak. Sesudah
periode pemulihan pasien tdk me-ngalami masalah yg ber-hubungan dgn makanan.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo138; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Merupakan
indikai sumba-tan saluran empedu/ ggn degestif, dpt digunakan utk evaluasi
& intervensi</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l10 level1 lfo139; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Kebiasaan
aktifitas dapat dimulai lagi secara normal dalam waktu 4 - 6 minggu </span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.5pt;" valign="top" width="198">
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l18 level1 lfo140; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menanyakan
seberapa jauh klien mengetahui ttg proses penyakit, prosedur pembedahan serta
prog-nosa.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l18 level1 lfo141; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menganjurkan
klien untuk menjaga balutan luka agar tetap bersih dan kering.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l18 level1 lfo142; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menganjurkan
klien untuk mencatat pengeluaran cairan yang terkumpul di kantong T tube.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l18 level1 lfo143; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Memberitahu
pasien agar 4 - 6 bulan diberi diit rendah lemak.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l18 level1 lfo144; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menganjurkan
klien utk tidak minum alkohol.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l18 level1 lfo145; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Melakukan
diskusi dengan klien dan keluarga utk menghindari makanan yg dpt menimbulkan
deare.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-align: justify; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l18 level1 lfo146; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Memberitahu
utk mengi-dentifikasi & mencatat tan-da & gejala : urin keruh, warna
kuning pada mata dan kulit & warna feses.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l18 level1 lfo147; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Menganjurkan
klien utk membatasi aktifitas selama 4 - 6 minggu</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .75pt; mso-border-left-alt: solid windowtext .75pt; mso-border-top-alt: solid windowtext .75pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.5pt;" valign="top" width="198">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Century Gothic","sans-serif";">Tgl
1 mei 1996</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Gothic","sans-serif";">S :Klien
menga-takan bahwa telah mengerti ttg pro-ses penyakit & prosedur
pembe-dahan yg telah dilakukan, klien sanggup utk men-jaga luka tetap bersih
& kering, klien sanggup me-ngikuti diit lemak & tdk merokok.& tdk
akan minum al kohol.</span></b><span style="font-family: "Century Gothic","sans-serif";"></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Gothic","sans-serif";">O:Kien dapat
menyebutkan atau menjawab dengan benar : operasi tujuannya utk mengeluarkan
batu empedu, dipasang drain utk mengeluarkan cairan sisa -sisa operasi,
posisi se-mifowlwer/duduk agar cairan keluar lancar, suntikan agar lukanya
capat sembuh. Balutan luka ke-ring, urine kuning , mata sedikit ikte-rus
feses lembek kuning.</span></b><span style="font-family: "Century Gothic","sans-serif";"></span></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Gothic","sans-serif";">A:</span></b><span style="font-family: "Century Gothic","sans-serif";"> Pengetahuan kli en ttg.
peny, pe nyebab, prognosa , faktor resiko yg terjadi.</span></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Gothic","sans-serif";">P :</span></b><span style="font-family: "Century Gothic","sans-serif";">lanjutkan Inter-vensi nomor
4, 5, 7, 8 ,9. diteruskan. Dischart planing :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo148; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Diit
rendah le-mak (kola-borasi).</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo149; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Mengurangi
aktifitas sesuai anjuran 4 - 6 bln.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo150; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Century Gothic","sans-serif"; mso-bidi-font-family: "Century Gothic"; mso-fareast-font-family: "Century Gothic";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Century Gothic","sans-serif";">Control
teratur</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 10.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: right;" />
</span>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-58601097446046780862011-11-10T07:35:00.001-08:002011-11-10T07:35:43.534-08:00Hidrocephalus<!--[if !mso]>
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<div class="MsoTitle">
<u>ASUHAN KEPERAWATAN BAYI DENGAN HIDROCEPHALUS</u></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengertian</div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 1.0cm;">
Hidrocephalus
adalah sebuah kondisi yang disebabkan oleh produksi yang tidak seimbang dan
penyerapan dari cairan cerebrospinal (CSF) di dalam sistem Ventricular.
Ketika<span style="mso-spacerun: yes;"> </span>produksi CSF lebih besar dari
penyerapan, cairan cerebrospinal mengakumulasi di dalam sistem Ventricular.</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";">
</span></span>Etiologi</div>
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1)<span style="mso-tab-count: 1;"> </span>Gangguan cairan cerebrospinal</div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: -3.8pt;">
2)<span style="mso-tab-count: 1;"> </span>Hambatan cairan cerebrospinal menuju sistem
ventricular.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">III.<span style="font: 7.0pt "Times New Roman";"> </span></span>Patofisiologi</div>
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Sirkulasi
cairan ventrikel mengalir dari cabang sampai ke ruang ventrikel, melalui
Foramen Monro menuju ventrikel ketiga, tempat ia bergabung dengan cairan yang
keluar pada ventrikel ketiga tersebut. Dari sini cairan mengalir melalui
saluran Sylvius menuju ventrikel keempat tempat banyak cairan dibentuk,
kemudian menuju cabang samping foramen luschka dan garis tengah foramen
Magendie ke dalam Cisterna Magna. Kemudian mengalir ke bagian otak dan diserap
oleh beberapa mekanisme antara lain arachnoid villi, sinuses (lubang yang
menghubungkan rongga hidung dengan batak otak, pembuluh darah kecil dan otak.</div>
<div class="MsoNormal" style="text-indent: 18.0pt;">
<i style="mso-bidi-font-style: normal;">Mekanisme Ketidakseimbangan Cairan</i></div>
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Jarang terjadi
sebuah tumor choroid plexus menyebabkan perkembangan pengeluaran cairan
cerebrospinal dalam ventrikel, yang menjadi bertambah banyak dan memadat pada
inti otak. </div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 1.0cm;">
<span style="mso-tab-count: 1;"> </span>Hidrocephalus yang non komunikans
adalah gangguan penyerapan cairan cerebrospinal, sedangkan adanya hubungan
cairan cerebrospinal menuju sistem ventricular digolongkan pada Hidrocephalus
yang komunikans. Banyak masalah yang timbul berkaitan dengan Hidrocephalus yang
non komunkans yaitu cacat. Meskipun cacat itu biasanya nampak pada masa kecil
yang lebih awal, itu bisa menjadi bukti bahwa hal tersebut telah ada sebelum
lahir bagi anak-anak yang lahir terlambat maupun orang dewasa yang lahir
prematur. Sebab lain mencakupi neoplasma, infkesi dan trauma. Hambatan cairan
normal dapat terjadi pada saluran cairan cerebrospinal yang mengakibatakan
peningkatan tekanan dan pembesaran pada saluran terdekat di tempat hambatan.</div>
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Tempat
yang paling banyak ada hambatan adalah :</div>
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<tbody>
<tr style="height: 19.0pt;">
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<h1>
<span style="font-weight: normal; mso-bidi-font-weight: bold;">TEMPAT DAN
JENIS</span></h1>
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<span style="mso-bidi-font-weight: bold;">SEBAB DAN KOMENTAR</span></div>
</td>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">*<span style="mso-tab-count: 1;"> </span>Hidrocephalus non komunikans :</span></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Tempat<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>Saluran
Sylvius</span></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Jenis<span style="mso-tab-count: 2;"> </span>:<span style="mso-tab-count: 1;"> </span>Stenosis/Atresia</span></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Gliosis</span></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Obstructive</span></div>
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<br /></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Tempat<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>Kamar jantung keempat dan
foramen magna</span></div>
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<br /></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Tipe<span style="mso-tab-count: 2;"> </span>:<span style="mso-tab-count: 1;"> </span>Cacat Chiori</span></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Cacat Arnold Chiari</span></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Kemacetan ruang jantung</span></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Berjumlah
20% Hidrocephalus</span></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Berjumlah
50% dari semua Hidrocephalus</span></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 218.7pt;" valign="top" width="292">
<div class="MsoNormal" style="margin-left: 1.0cm; tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm; text-indent: -1.0cm;">
<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">*<span style="mso-tab-count: 1;"> </span>Hidrocephalus komunikan :</span></div>
<div class="MsoNormal" style="margin-left: 2.0cm; tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm; text-indent: -1.0cm;">
<br /></div>
<div class="MsoNormal">
Tempat<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>Arachnoid Villi dan cisterna magna</div>
<div class="MsoNormal" style="margin-left: 4.0cm; tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm; text-indent: -3.0cm;">
<br /></div>
<div class="MsoNormal" style="margin-left: 4.0cm; tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm; text-indent: -3.0cm;">
<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Jenis<span style="mso-tab-count: 2;"> </span>:<span style="mso-tab-count: 1;"> </span>Meningitis</span></div>
<div class="MsoNormal" style="margin-left: 4.0cm; tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm; text-indent: -3.0cm;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 218.7pt;" valign="top" width="292">
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Arachnoid
yang tebal</span></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Bakteri</span></div>
</td>
</tr>
</tbody></table>
</div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 1.0cm;">
<span style="mso-spacerun: yes;"> </span>Contoh perkembangan abnormal atau kerusakan :
cacat Arnold Chiari, saluran yang mengalami Stenosis, saluran Gliosis dan
Atresin foramina lushcka, dan hal kepala membesar pada usia dua tahun, yang
harus sudah diperiksa ketika masih bayi demi perkembangannya. Ada masalah
menetap seperti infkesi intra uterine dan bakteri-bakteri sebelum dan saat
kelahiran (prenatal hemorrhage, neonatal meningoencephalistis). Cacat Arnol
Chieri adalah gangguan yang melibatkan isi prosterior fossa. Pada masa bayi
kepala bertumbuh secara tak normal meskipun tanda pertama tanpa pembesaran atau
tambahan. Bagian depan kepala biasanya keras. Pembuluh darah kepala akan
membesar ketika bayi menangis. Semakin keras bayi itu menangis, tulang
tengkorak menjadi tipis dan jahitan bedah menjadi jelas terpisah dan
menghasilkan bunyi-bunyi aneh. Pembesaran pada garis depan membuat mata murung.</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">IV.<span style="font: 7.0pt "Times New Roman";"> </span></span>Penatalaksanaan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 1.0cm;">
Pengobatan pada
hidrocephalus langsung diberikan kepada :</div>
<div class="MsoNormal" style="margin-left: 1.0cm; text-indent: -14.15pt;">
1.<span style="mso-tab-count: 1;"> </span>Mengurangi hidrocephalus itu sendiri</div>
<div class="MsoNormal" style="margin-left: 1.0cm; text-indent: -14.15pt;">
2.<span style="mso-tab-count: 1;"> </span>Mengobati komplikasi</div>
<div class="MsoNormal" style="margin-left: 1.0cm; text-indent: -14.15pt;">
3.<span style="mso-tab-count: 1;"> </span>Mengatasi masalah yang berhubungan dengan efek
pada gangguan perkembangan psikomotor.</div>
<div class="MsoNormal" style="text-indent: 14.2pt;">
Pengobatan itu dilakukan dengan
beberapa cara keucali operasi pembedahan. Terapi medis sangat mengecewakan,
banyak bayi yang lahir dengan pendarahan terus-menerus yaitu sambungan syaraf
mengalami kebocoran dan pengobatan sudah banyak dilakukan namun tidak membawa
hasil yang memuaskan. Pada tindakan lumbal fungsi yang serial dan medication
yang digunakan hasilnya sangat bervariasi.</div>
<div class="MsoNormal">
Pengobatan dengan acetazolamide dan isosorbide atau
furosimida dapat menekan produksi CSF pada setiap kasus.</div>
<div class="MsoNormal">
<i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-weight: bold;">Pengobatan dengan </span></i>pembedahan
(Operasi)</div>
<div class="MsoNormal" style="margin-left: 1.0cm; text-indent: -14.15pt;">
Penanganan
bedah merupakan terapi pilihan pada sejumlah kasus hidrocephalus.</div>
<div class="MsoNormal" style="margin-left: 1.0cm; text-indent: -14.15pt;">
Cara ini
dengan secara langsung untuk mengeluarkan sumbatan-sumbatan sebagai contoh
receptio neoplasma, kiste, hematom, jarang terjadi pada produksi cairan yang
berlebihan, exterpasi plexus (pleboctomy atau coagulasi electric) namun banyak
anak membutuhkan prosedur shunt yang mengakibatkan pengaliran CSF dari
ventrikel ke bagian extracranial peritonium. Sistem shunt terdiri dari cateter
ventrikel, flush pompa, katup aliran unidirectional dan sebuah ujung cateter.
Semuanya merupakan radiopaq untuk pengamatan setelah placemen. Semuanya dicoba
ketepatannya sebelum incersi. Sebuah recervoir ditambahkan untuk mengalirkan
secara langsung ke dalam sistim ventrikular untuk memberikan obat-obatan dan
mengeluarkan cairan. Untuk semua model katup dibentuk untuk membuka dan
menutup. Membuka sebelum terjadi tekanan pada intraventrikuler dan menutup
ketika tekanan berada dibawah level yang normal, semuanya untuk mencegah aliran
kembali. Tekanan tinggi pada katup untuk mencegah komplikasi dari decompretion
pada ventrikel dan tekanan sedang pada katup digunakan pada anak-anak khususnya
pada long standing hidrocephalus sedangkan tekanan rendah pada bayi kecil.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Komplikasi</h2>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Komplikasi terbesar pada VP Shunt
adalah infeksi dan malfungsi. Malfungsi lebih sering disebabkan oleh obstruksi
mekanik di dalam ventrikel dari bahan-bahan khusus (jaringan atau exudate) atau
ujung distal dari trombosis atau displacement sebagai akibat dari pertumbuhan.
Anak dengan obstruksi shunt sering menunjukan kegawatan dengan manifestasi
klinik peningkatan ICP, yang lebih sering disertai dengan status neorologis
yang jelek.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
Komplikasi
yang sering terjadi adalah infkesi shunt yang dapat terjadi setiap saat tetapi
resiko terbesar terjadi pada 1-2 bulan mengikuti placement. Infeksi umumnya
akibat dari intercurent infection pada saat shunt placement. Infeksti itu
meliputi septik, endocarditis bacterial, infeksi luka, nefritis shunt, meningitis
dan ventrikulitis. Meningitis dan ventrikulitis adalah of greatest concern,
selama ditemukan komplikasi infeksi CNS. Infeksi dapat diobati dengan
pengobatan pasive antibiotika yang diberikan secara intravena. Sebagian infeksi
membutuhkan removal of the shunt sampai infeksi dapat dikontrol. External
ventricular drainase digunakan sampai CSF steril.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
Sebuah
komplikasi shunt yang serius adalah hematoma subdural yang disebabkan oleh
reduksi yang cepat pada ICP dan ukurannya. Komplikasi yang dapat terjadi adalah
peritonitis abses abdominal, perporasi organ-organ abdomen oleh catater atau
trokar (pada saat insersi), fistula hernia dan ilius.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Prognosis</h2>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Prognosis pada anak tergantung
besarnya kecepatan perkembangan hidrocephalus, durasi peningkatan ICP dan frekwensi
komplikasi, dan penyebab hidrocephalus. Sebagai contoh tumor-tumor ganas dapat
menyebabkan mortalitas yang tinggi berhubungan dengan faktor-faktor komplikasi
yang lain.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
Hidrocephalus
tak terobati mempunyai 50-60% mortalitis rate akibat disorder atau intercurent
illneses. Secara spontan pada kasus hidrocephalus 40% dengan intelegensi
mendekati normal.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
Akibat
tindakan pembedahan 80% insident tertinggi mortalitas terjadi dalam tahun
pertama pengobatan.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
Pada
anak-anak dengan hidrocephalus juga beresiko terhadap masalah perkembangan dan
emosional seperti cemas, neorosis atau gangguan sikap anti sosial. Pada umumnya
hidrocephalus non infeksi menunjuk prognosis baik sedangkan hidrocephalus
biasanya disertai dengan cerebral defect.</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">V.<span style="font: 7.0pt "Times New Roman";">
</span></span>Asuhan Keperawatan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level5 lfo1; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengkajian.</div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;">Identitas.</li>
</ol>
<div class="MsoNormal" style="margin-left: 36.0pt;">
Menurut T.H. Rampengan dan I.R.
Laurentz diperkirakan insiden demam tifoid pada tahun 1985 di Indonesia adalah
sebagai berikut umur 0-4 tahun 25,32 %, umur 5-9 tahun 35,59 % dan umur 10-14
tahun 39,09%. Namun menegakkan diagnosis demam tifoid pada anak merupakan hal
yang tidak mudah mengingat tanda dan gejala klinis yang tidak khas terutama
pada penderita di bawah usia 5 tahun. Insiden penyakit ini tidak berbeda antara
anak laki dan anak perempuan, tergantung pada status gizi dan status imunologis
penderita. </div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;">Riwayat
Keperawatan.</li>
</ol>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Keluhan utama. </div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Demam lebih dari 1 minggu,
gangguan kesadaran : apati sampai somnolen, dan gangguan saluran cerna seperti
perut kembung atau tegang dan nyeri pada perabaan, mulut bau, konstipasi atau
diare, tinja berdarah dengan atau tanpa lendir, anoreksia dan muntah.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat penyakit sekarang.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Ingesti makanan yang tidak
dimasak misalnya daging, telur, atau terkontaminasi dengan minuman. </div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat penyakit dahulu.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 18.0pt;">
Pernah
menderita penyakit infeksi yang menyebabkan sistem imun menurun.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat kesehatan keluarga.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Tifoid kongenital didapatkan dari
seorang ibu hamil yang menderita demam tifoid dan menularkan kepada<span style="mso-spacerun: yes;"> </span>janin melalui darah. Umumnya bersifat fatal.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat kesehatan lingkungan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Demam tifoid saat ini terutama
ditemukan di negara sedang berkembang dengan kepadatan penduduk tinggi serta
kesehatan lingkungan yang tidak memenuhi syarat kesehatan. Pengaruh cuaca
terutama pada musim hujan sedangkan dari kepustakaan barat dilaporkan terutama
pada musim panas.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Imunisasi. </div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Pada tifoid kongenital dapat
lahir hidup sampai beberapa hari dengan gejala tidak khas serta menyerupai
sepsis neonatorium.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat pertumbuhan dan perkembangan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Nutrisi.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 18.0pt;">
Gizi buruk
atau meteorismus</div>
<ol start="3" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;">Pemeriksaan
fisik.</li>
</ol>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem kardiovaskuler.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 18.0pt;">
Takikardi,
hipotensi dan shock jika perdarahan, infeksi sekunder atau septikemia.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem pernapasan.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 18.0pt;">
Batuk
nonproduktif, sesak napas.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem pencernaan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Umumnya konstipasi daripada
diare, perut tegang, pembesaran limpa dan hati, nyeri perut pada perabaan,
bising usus melemah atau hilang, muntah, lidah tifoid dengan ujung dan tepi
kemerahan dan tremor, mulut bau, bibir kering dan pecah-pecah.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem genitourinarius.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 18.0pt;">
Distensi
kandung kemih, retensi urine.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem saraf.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Demam, nyeri kepala, kesadaran
menurun : delirium hingga stupor, gangguan kepribadian, katatonia, aphasia,
kejang.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem lokomotor/muskuloskeletal.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 18.0pt;">
Nyeri sendi</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem endokrin.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Tidak ada kelainan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem integumen.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Rose spot dimana hilang dengan
tekanan, ditemukan pada dada dan perut, turgor kulit menurun, membran mukosa
kering.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem pendengaran.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 18.0pt;">
Tuli ringan
atau otitis media.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">j.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sistem penciuman.</div>
<ol start="4" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;">Pemeriksaan
diagnostik dan hasil.</li>
</ol>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 1.0cm;">
<span style="mso-tab-count: 1;"> </span>Diagnosa yang dilakukan pada masa kecil
dari kepala busung sudah mendasar dan melingkar pada kepala, mengaliri satu
atasu lebih banyak jalur pada peta selam satu peirode dari dua sampai empat
minggu dan asosiasi neorologi berpendapat bahwa memang itu ada dan berkembang.
Dengan kata lain diagnosa dipelajari untuk kebutuhan, lokalisasi bagi ikuran
halangan, kebanyakan ukuran rontgen pada kepala telah membawa ketidakdewasaan
dengan terdapatnya infeksi nyelomeningocele dan tulang bagian dalam.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 1.0cm;">
<span style="mso-tab-count: 1;"> </span>Pada suatu evaluasi tentang
ketidakdewasaan yang dibawa sejak kecil dikutip bahwa kebanyakan terdapat pada
kepala. Semua dikonultasikan agar bila membuktikan tentang ketidakwajaran
pertumbuhan mulai dari cepat dan tidak normal. Keutamaan diagnosa sendiri untuk
digunakan pada pendeteksian Hidrocephalus sejak anak sudah ada gambaran.
Evaluasi diagnosa pada anak-anak yang mempunyai gejala Hidrocephalus setelah
bayi sangat sama bagi mereka yang menghidap tumor.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 1.0cm;">
Ukuran kepala
bisa berasal dari karakter keluarga.</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
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<br /></div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Masa Anak-anak</h2>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Tanda-tanda dan gejala dari anak-anak
yang mengalami perkembangan terlambat berasal dari Neoplasma Posterios Fossa
dan saluran Stenosis dan manifestasi klinikal. Ini semua mengakibatkan sakit
kepala dan beberapa hal terjadi pada diri anak antara lain lekas marah, lesu,
bingung dan hilangnya kontak dengan sesama. Pada salah satu alat bantu untuk
membantu orang cacat berjalan, manifestasi mejadi tampak banyak dan membuat
bayi takut.</div>
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<span style="mso-tab-count: 1;"> </span>Manifestasi cacat bagi bayi berumur
tiga tahun ke atas lebih berhubungan dengan syaraf tulang belakang ketimbang
berkaitan dengan penempaan yang biasanya terpancar lewat kemarahan.</div>
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<br /></div>
<h2>
Manajemen Terapi</h2>
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<br /></div>
<h2>
Nursing Konsiderasi</h2>
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<span style="mso-tab-count: 1;"> </span>Perawatan anak dengan hidrocephalus
meliputi manajemen preoperasi dan post operasi. Juga penting dalam mengkaji
dengan teliti anak dengan myelomeninggocele terhadap tanda-tanda meningkatnya
ICP, timbulnya hidrocephalus biasa dihubungkan dengan anomaly.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Pengkajian</h2>
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<span style="mso-tab-count: 1;"> </span>Preoperasi pada infant yang telah
didiagnosa atau pada hidrocephalus sedang diobservasi secara teliti terhadap
meningkatnya tanda-tanda ICP. Pada anak-anak kepala diikur setiap hari untuk
menentukan besaran kepala/CFC. Untuk mencegah kemungkinan ketidaksesuaian yang
besar dalam pengukuran untuk itu dipakai kertas ukuran yang sudah ada dan
diberi tanda dengan pulpen. Garis pontanela dan sutura diukur secara hati-hati,
dan tanda yang menonjol waktu dan pemisahan. Pada anak-anak dengan
Hidrocephalus dan normal ICP anak menampakan secara menonjol keadaan yang nyata
seperti ketegangan atau jeritan karena itu semua kelakuan yang menyertai harus
dicatat.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
Iritabel,
letargi, dan gangguan aktivitas, seperti pada tanda-tanda vital, kebiasaan
makan dapat diidentifikasi kemajuan yang pathologis. Untuk anak-anak yang telah
mendapat perawatan di rumah sakit untuk pelayanan shunt baik rutin maupun
emergency kebanyak nilai indikator pada kenaikan ICP lebih tinggi untuk
tingkatan anak dengan kesadaran kurang, dengan cara itu anak berinteraksi
dengan lingkungan perubahan diidentifikasi dengan observasi, dan dengan
membandingkan dengan keadaan sekarang dengan keadaan sebelumnya, pola tidur,
perkembangan kemampuan dan kebiasaan sehari-hari melalui riwayat rinci dan
dasar pengkajian. Infromasi dasar memberikan petunjuk untuk pengkajian dan
evaluasi setelah operasi pada shunt function</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Diagnosa Perawatan</h2>
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<span style="mso-tab-count: 1;"> </span>Setelah pengkajian keperawatan diikuti
dengan diagnosa keperawatan agar lebih jelas. Mungkin sebagian diagnosa adalah
garis bersar dan dibahas dalam NCP</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Perencanaan</h2>
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<span style="mso-tab-count: 1;"> </span>Tujuan akhir perawatan anak dengan
hidrocephalus adalah :</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
1.<span style="mso-tab-count: 1;"> </span>Pencegahan komplikasi pada hidrocephalus
dan atau observasi pembedahan.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
2.<span style="mso-tab-count: 1;"> </span>Penyaluran pendidikan emoasi serta
dukungan dari keluarga.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Implementasi</h2>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Perawat perlu menyediakan makanan
khusus bagi pasien. Sedikit makan secara terus-menerus lebih baik ketimbang
sekali makan dalam jumlah yang banyak. Seorang perawat bertanggung jawab atas
persiapan anak dalam mengikuti test diagnosa yaitu tomografy dan bersedia
membantu dokter. Sebelum mengadakan operasi, ukuran kepala perlu diambil untuk
mengetahui perkembangan kepala.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Perawatan Setelah Operasi</h2>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Setelah operasi, pasien boleh
ditidurkan secara rata, dan perlu diperhatikan agar tidak boleh ada tekanan
terhadap daerah yang dioperasi. Upaya mengetahui tekanan darah harus dilakukan
terus menerus.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<br /></div>
<h2>
Dukungan Keluarga</h2>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Kebutuhan-kebutuhan khusus dari orang
tua selama mas pengoatan dihubungkan dengan alasan pengobatan anak (melangsir,
ulang infeksi, diangosa) dan penelitian serta aturan yaitu anak menjadi
sasaran. Sering orang tua memiliki sangat sedikit tentang ilmu pembedahan dan
ilmu anatomi. Karena itu mereka membutuhkan penjelasan, penguatan dan informasi
banyak dari ahli psikis dan neuron, sebanyak informasi yang mereka butuhkan.
Perawat perlu melakukan banyak untuk menghilangkan kegelisahan dengan
penjelasan-penjelasan rasional dan jenis perawatan yang beragam.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Sebagai persiapan untuk mengalai
perubahan dan penjagaan anak, orang tua melatih diri bagaimana mengenal tanda
yang menunjukkan kegagalan pemakaian atau tanda-tanda infeksi dan bagaimana
menepa kuat, bila perlu. Anak-anak yang aktif bisa mendapat musibah seperti
pengguguran yang dapat menghancurkan.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
Pengaturan
kepala busung pada seorang anak adalan tuntutan bagi keluarga dan
profesionalisme kesehatan dan pertolongan kepala keluarga untuk anak-anak
sebagai obyek perawatan penting. Penting untuk ditekankan bahwa Hidrocephalus
adalah masalah hidup yang panjang dan bahwa anak membutuhkan evaluasi pada
sebuah aturan dasar. Tujuan pekerjaan ini adalah membangun sebuah tujuan nyatan
dan program pendidikan yang membantu anak dalam pencapaian kemampuan optimal.
Keluarga dapat menyerahkan dukungan kepada wakil komunitas dan pimpinan.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Penyediaan informasi mengenai keadaan
keluarga, sangat membantu kelompok yang tertarik untuk membangun organisasi
lokal. Proses yang tersedia sangat membantu dan sumber-sumber lain.</div>
<div class="MsoNormal" style="tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
<span style="mso-tab-count: 1;"> </span>Antisipasi bimbingan akan menyiapkan
orang tua bagi masalah-masalah yang mungkin terjadi dan menolong mereka dari
keterlaluan atau kelebihan melindungi anak. Dibutuhkan tempat aktivitas
anak-anak (sebagian besar berhubungan dengan olahraga). Anak dibesarkan
hati/diberanikan agar hidup seperti orang lain yang sama umur dan kemampuan.
Orang membutuhkan dorongan yang baik bagi anak-anak dan persoalan-persoalan
yang mungkin dialami, anak-anak yang umurnya sebaya dan dengan orang lain.
Reaksi dari anak-anak lain ketika anak itu kelihatan sedang berpikir atau
memutuhkan waktu untuk memperbaiki situasi merupakan stress anak maupun orang
tua.</div>
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<br /></div>
<h2>
Evaluasi</h2>
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<span style="mso-tab-count: 1;"> </span>Penetapan bantuan perawatan yang
efektif secara tekun dan terus-menerus, serta evaluasi perawatan berdasarkan
observasi.</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="page-break-before: always;" />
</span>
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<span style="height: 597px; left: -3px; mso-ignore: vglayout; position: relative; top: 14px; width: 576px; z-index: 251657728;">
</span></div>
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td bgcolor="white" height="583" style="background: white; border: 1.0pt solid black; vertical-align: top;" width="576"><span style="left: 0pt; mso-ignore: vglayout; position: absolute; z-index: 251657728;">
<table cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td>
<div class="shape" style="padding: 4.6pt 8.2pt 4.6pt 8.2pt;">
<h1>
NURSING CARE PLANNING</h1>
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1.<span style="mso-tab-count: 1;"> </span>Potensial injuri berhubungan dengan
peningkatan tekanan intrakranial.</div>
<div class="MsoNormal" style="margin-left: 1.0cm; tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm;">
Tujuan<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>Menghindari
peningkatan tekanan intrakranial</div>
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Intervensi<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>1.<span style="mso-tab-count: 1;"> </span>Setelah operasi, rawat shunt sesuai
ketentuan</div>
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2.<span style="mso-tab-count: 1;"> </span>Atur posisi untuk memudahkan aliran
dari cairan cerebrospinalis.</div>
<div class="MsoNormal" style="margin-left: 5.0cm; tab-stops: 1.0cm 2.0cm 3.0cm 4.0cm 5.0cm 6.0cm 7.0cm 8.0cm 9.0cm 10.0cm 11.0cm 12.0cm 13.0cm 14.0cm; text-indent: -1.0cm;">
3.<span style="mso-tab-count: 1;"> </span>Observasi terhadap tanda-tanda awal
meningkatnya ICP seperti irritability, letargic, perubahan tingkat
kesadaran, sakit kepala, sutura-sutura terpisah, apatis, bingung.</div>
<div class="MsoNormal" style="margin-left: 1.0cm;">
Hasil yang diharapkan : anak
tidak menunjukan tingkatan tekanan intrakranial yang nyata.</div>
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<br /></div>
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2.<span style="mso-tab-count: 1;"> </span>Potensial infeksi berhubungan dengan
tekanan pada sistim drainase mekanik.</div>
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Tujuan<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>Menghindari
infeksi</div>
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Intervensi<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>Lakukan
perawatan luka sesuai standar</div>
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Hasil
yang diharapkan : anak tidak menunjukan tanda-tanda infeksi yang nyata.</div>
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<br /></div>
<div class="MsoNormal">
3.<span style="mso-tab-count: 1;"> </span>Gangguan
proses keluarga berhubungan dengan anak dengan deffect cronic</div>
<div class="MsoNormal" style="margin-left: 1.0cm;">
Tujuan<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>Dukungan
keluarga</div>
</div>
</td>
</tr>
</tbody></table>
</span> </td>
</tr>
</tbody></table>
<br />Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-9087460553478386232011-11-10T07:33:00.001-08:002011-11-10T07:35:06.553-08:00DERMATITIS<!--[if gte mso 9]><xml>
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<b>ASUHAN KEPERAWATAN
PADA DERMATITIS DAN EXZEMA</b>.</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<h1 style="margin-left: 54.0pt; mso-list: l0 level1 lfo3; tab-stops: list 27.0pt; text-indent: -54.0pt;">
<span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span>EXZEMA / DERMATITIS.</h1>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 45.0pt; mso-list: l0 level2 lfo3; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";">
</span></span>DEFINISI.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
Merupakan reaksi inflamasi kulit
terhadap unsur – unsur fisik, kimia, biologi.( brunner and suddarth , 2002 )</div>
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Reaksi peradangan kulit yang
karacteristic terhadap berbagai rangsangan endogen ataupun exogen ( harahap M.
2000 ).</div>
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Exzema dari bhs yunani “ eksein”
: menggambarkna epidermis mengalami spongioisis yaitu adanya vesikula
intraepidermal yang terjadi karena adanya edema interseluler.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 45.0pt; mso-list: l0 level2 lfo3; tab-stops: list 45.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span>Tipe
dermatitis secara umum.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 63.0pt; mso-list: l6 level1 lfo1; tab-stops: list 63.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span>Dermatitis
endogen</div>
<div class="MsoNormal" style="margin-left: 63.0pt; mso-list: l6 level1 lfo1; tab-stops: list 63.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span>Dermatitis
eksogen</div>
<div class="MsoNormal" style="margin-left: 63.0pt; mso-list: l6 level1 lfo1; tab-stops: list 63.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span>Dermatitis
yang belum jelas penyebabnya.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 80.0pt; mso-list: l12 level1 lfo4; tab-stops: list 81.0pt; text-indent: -17.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span>Dermatitis
endogen terbagi menjadi: </div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Dermatitis
atopik, seboroik, liken simpleks kronis, dermatitis nonspesifik ( pompoliks, D.
numuler, D. xerotik, D. otosensitisasi ) dan D. karena obat.</div>
<div class="MsoNormal" style="margin-left: 80.0pt; mso-list: l12 level1 lfo4; tab-stops: list 81.0pt; text-indent: -17.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span>Dermatitis
Eksogen terbagi menjadi : kontak iritan, D. kontak iritan, D. foto alergik, D.
infektif, Dan dermatofitid.</div>
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<br /></div>
<ol start="1" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="mso-list: l1 level1 lfo2; tab-stops: list 36.0pt;"><b>Dermatitis
.</b></li>
</ol>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level2 lfo2; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span><b>Macam
– macam dermatitis.</b></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>Dermatitis atopik adalah </b>dermatitis yanmg
tejadi pada seseorang yang mempunyairiwayat atopi.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>Dermatitis seboroik </b>adalah peradangan
kulit yang sering terjadi pada daerah tubuh berambut terutam pada kulit kepala
alis mata dan muka, kronik dan superfisialis.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>Liken simplek kronik adalah </b>dermatitis
dengan penebalan kulit dari jaringan tanduk karena garukan ataugosokan yang
berulang – ulang.</div>
<div class="MsoNormal" style="margin-left: 81.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>Dermatitis stasis adalah </b>dermatitis
yangterjadi akibat adanya gangguan aliran darah vena ditungkai bawah.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>Dermatitis / exzema nonspesifik </b>adalah
suatu erupsi epidermal yang dapat berlangsung akut, kranik, terlokalisasi dan
generalis.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>D. Pomfolik </b><span style="mso-spacerun: yes;"> </span>adalah dermatitis yang ditandai dengan adanya
vesikula yang dalam, mengenai telapak tangan / kaki, dan jari – jari.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>D. otosensitisasi </b><span style="mso-spacerun: yes;"> </span>merupakan perluasan yang ceapat dari reksi
exzematus atau vesikuler.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>D. numuler adalah </b><span style="mso-spacerun: yes;"> </span>dermatitis yang bentuk lesinya bulat seperti
uang logam.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>D. xerotik </b>merupakan dermatitis yang
terjadi pada musim dingin dan banyak dijumpai pada orang tua dan punya
predisposisi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>D. medikamentosa </b>adalah peradangan pada
kulit akibat reaksi dari obat.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>D. kontak </b>adalah dermatitis yang disertai
dengan adanya spongiosis / edema interseluler pada epidermis karena kulit
berinteraksi langsung dengan bahan kimia.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>D. infektif </b><span style="mso-spacerun: yes;"> </span>adalah dermatitis yang disebabkan oleh
mikroorganisme atau produknya dan menyembuh jika organismenya sudah diobati.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>Dermatofitid : </b>adalah Reaksi alergi dari
dermatifites</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l7 level1 lfo7; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><b>D. eksfolatifa generalisata</b> adalah
peradangan yang ditandai dengan adanya eritema, dan skuama yang hampir mengenai
seluruh tubuh.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 54.0pt; text-indent: -18.0pt;">
a.<span style="mso-tab-count: 1;"> </span><b>Pengertian dermatitis Atopik</b>.</div>
<div class="MsoBodyTextIndent" style="margin-left: 54.0pt;">
Sinonim : prurigo
besnier, neurodermatitis, desimenata, exzema konstitusional.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
DA adalah dermatitis yg terjadi
pada orang yang mempunyai riwayat atopi. </div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Atopi bersal dari bhs yunani “
berarti”:<span style="mso-spacerun: yes;"> </span>penyakit aneh /
hipersensitivitas.</div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b>Etiologi.</b></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Bahan iritan, allergen ( sabun,
deterjen, bahan pembersih, dan kimia industri yang lain).</div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b>Manifestasi
klinik.</b></div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<span style="mso-tab-count: 1;"> </span>Rasa gatal, eritema,
perubahan histologik dengan sel Radang yang bulat,</div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<span style="mso-tab-count: 1;"> </span>edema eridermal yang
spongiostik, edema, papula, vesikel serta perembasan</div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<span style="mso-tab-count: 1;"> </span>cairan atau secret,
pengelupasan kulit, likenifikasi, pigmentasi.</div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<span style="mso-tab-count: 1;"> </span>Sering terjadi pada
muka, lipatan kulit ( fosa cubiti, poplitea ).</div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 18.0pt;">
Pembentukan
krusta, pengeringan, pembentukan fissura. </div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b>Faktor
predisposisi </b></div>
<div class="MsoNormal" style="margin-left: 144.0pt; mso-list: l1 level4 lfo2; tab-stops: list 81.0pt; text-indent: -90.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Asma, konjungtivitis alergik, rinitis alergika, urtikaria
dan Reaksi dari</div>
<div class="MsoNormal" style="margin-left: 90.0pt; text-indent: -9.0pt;">
makanan.</div>
<div class="MsoNormal" style="margin-left: 144.0pt; mso-list: l1 level4 lfo2; tab-stops: list 81.0pt; text-indent: -90.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Keadaan panas dingin yang extrem</div>
<div class="MsoNormal" style="margin-left: 144.0pt; mso-list: l1 level4 lfo2; tab-stops: list 81.0pt; text-indent: -90.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Kontak dengan iritan dengan frekuensi yang sering</div>
<div class="MsoNormal" style="margin-left: 144.0pt; mso-list: l1 level4 lfo2; tab-stops: list 81.0pt; text-indent: -90.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Penyakt kulit yang ada sebelumnya.</div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b>Patofisiologi</b></div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<span style="mso-tab-count: 1;"> </span>Peningkatan Imunoglobin
E ( Ig E ) dalam darah / tubuh serta terjadi</div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<span style="mso-tab-count: 1;"> </span>peningkatan histamin
kulit dan darah sebagai marker untuk adanya aktifitas</div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<span style="mso-tab-count: 1;"> </span>sel mast dan basofil.</div>
<div class="MsoNormal" style="margin-left: 72.0pt; tab-stops: list 54.0pt; text-indent: -36.0pt;">
<span style="mso-tab-count: 1;"> </span>Sel langerhans juga
meningkat.</div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
Pada lesi yang akut djumpai
spongiosis, vesikula, dan edema interselular, sel peradangan yang domonan
adalah limfosit. Sel endotel mengalami hipertropi, pada lesi likenifikasi<span style="mso-spacerun: yes;"> </span>yang kronis dijumpai penebalan epidermal
serabut saraf mengalami demielinisasi dan sclerosis akibat dari iskemi.</div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l6 level2 lfo1; tab-stops: list 117.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>faktor turunan atauy genetic juga bisa, yang diturunkan
secara outosomal, resesif autosomal, dan multifactoral.</div>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l6 level2 lfo1; tab-stops: list 117.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Faktor imunologi :<span style="mso-spacerun: yes;">
</span>Peningkatan Imunoglobin E ( Ig E ) dalam darah / tubuh serta terjadi
peningkatan histamin kulit dan darah sebagai marker untuk adanya aktifitas sel
mast dan basofil.</div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
Peningkatan aktivitas limfosit
karena pengaruh dari IL –4 , yang dipengaruhi oleh aktifitas sel T helper.</div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
sel TH2 merangsang sel B
memproduksi Ig E.</div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
<br /></div>
<ol start="1" style="margin-top: 0cm;" type="A"><ol start="6" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="mso-list: l1 level2 lfo2; tab-stops: list 72.0pt;"><b>Diagnosis
</b></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 72.0pt;">
Dagnosis ditegakan apabila ada
tiga criteria mayor dan ditambah 3 kriteria minor , serta criteria Svensson,
criteria William dan criteria berdasarkan SCORAD yang menggunakan foto
berwarna.</div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
<br /></div>
<ol start="1" style="margin-top: 0cm;" type="A"><ol start="7" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="mso-list: l1 level2 lfo2; tab-stops: list 72.0pt;"><b>Penatalaksanaan.</b></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l1 level3 lfo2; tab-stops: list 99.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tindakan umum: </div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberitahu rencana pengobatan yang akan diberikan pada
klien</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>keluarga.</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Latihan gerak ringan untuk menghilangkan gelisah.</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Mempertahankan kelembaban ruangan<span style="mso-spacerun: yes;"> </span>50% - 60 % untuk mencegah</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>kekeringan kulit.</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Mandi berendam denga air yang telah ditambah bahan
minyak .</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindari rangsanga pada kult .</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindari bahan pembersih yang dapa tmerangsang kulit.</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindari faktor pencetus.( seperti makanan, mikroba,
allergen dll ) </div>
<div class="MsoNormal" style="margin-left: 117.0pt; tab-stops: list 99.0pt; text-indent: -45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 117.0pt; tab-stops: list 99.0pt; text-indent: -45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l1 level3 lfo2; tab-stops: list 99.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengobatan :</div>
<div class="MsoNormal" style="margin-left: 144.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>kortikosteroid.</div>
<div class="MsoNormal" style="margin-left: 144.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Antihistamin.( klorfenraminel, hydroxizine dll.)</div>
<div class="MsoNormal" style="margin-left: 144.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Antibiotik : kloxasiline, eritromisine, sefalosporin
dll.)</div>
<div class="MsoNormal" style="margin-left: 144.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindari faktor penyebab.</div>
<div class="MsoNormal" style="margin-left: 126.0pt; mso-list: l1 level4 lfo2; tab-stops: list 126.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Kompres yang sejuk dan basah.</div>
<div class="MsoNormal" style="margin-left: 108.0pt; text-indent: 9.0pt;">
<br /></div>
<div class="MsoNormal">
<b>Perhatian</b> </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt;">
Untuk mencegah dermatitis
berulang :</div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l4 level1 lfo6; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Pelajari<span style="mso-spacerun: yes;"> </span>pola
dan lokasi dermatitis dan coba ingat benda apa yang terakhir emnempel pada pada
kult.</div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l4 level1 lfo6; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindari benda / bahan yang dapat menyebabkan Reaksi
dermatitis.</div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l4 level1 lfo6; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindari panas, sabun, dan gosokan,</div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l4 level1 lfo6; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindari pemakain obat secara bebas. </div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l4 level1 lfo6; tab-stops: list 81.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengistirahatkan kulit yang sakit dan melindungi dari
kerusakan lebih lanjut.</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 108.0pt; text-indent: -108.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 162.0pt; mso-list: l12 level3 lfo4; tab-stops: list 36.0pt; text-indent: -162.0pt;">
<b><span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b>Pengkajian.</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l12 level4 lfo4; tab-stops: list 72.0pt; text-indent: -36.0pt;">
<span style="mso-list: Ignore;">1).<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat kesehatan ( awitan , tanda dan gejala, lokasi,
dan durasi nyeri, gatal – gatal, ruam gangguan ras nyaman).</div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l12 level4 lfo4; tab-stops: list 72.0pt; text-indent: -36.0pt;">
<span style="mso-list: Ignore;">2).<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat alergi kulit</div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l12 level4 lfo4; tab-stops: list 72.0pt; text-indent: -36.0pt;">
<span style="mso-list: Ignore;">3).<span style="font: 7.0pt "Times New Roman";">
</span></span>Reaksi lergi t erhadap makanan</div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l12 level4 lfo4; tab-stops: list 72.0pt; text-indent: -36.0pt;">
<span style="mso-list: Ignore;">4).<span style="font: 7.0pt "Times New Roman";">
</span></span>Raeksi alergi terhadap obat kimia</div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l12 level4 lfo4; tab-stops: list 72.0pt; text-indent: -36.0pt;">
<span style="mso-list: Ignore;">5).<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat penyakit kulit sebelumnya.</div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l12 level4 lfo4; tab-stops: list 72.0pt; text-indent: -36.0pt;">
<span style="mso-list: Ignore;">6).<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat kanker.</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 63.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 162.0pt; mso-list: l12 level3 lfo4; tab-stops: list 36.0pt; text-indent: -162.0pt;">
<b><span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b>Diagnosis dan Intervensi.</b></div>
<div class="MsoNormal" style="margin-left: 27.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 251.0pt; mso-list: l12 level6 lfo4; tab-stops: list 63.0pt; text-indent: -215.0pt;">
<b><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b>kerusakan integritas kulit b/d kerusakan barier
kulit</b></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l12 level7 lfo4; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>lindungi kulit yang sehat terhadap kemungkinan
maserasi.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l12 level7 lfo4; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hilangkan kelembaban dengan menutulkan untuk menghisap
dan menghindari friksi.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l12 level7 lfo4; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Jaga dengan cermat terhadap resiko terjadinya cidera
termal akibat penggunaan compress hangat dengan suhu yang terlalu tinggi.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l12 level7 lfo4; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan pasien menggunakan kosmetik dan preparat tabir
surya.</div>
<div class="MsoNormal" style="margin-left: 63.0pt;">
</div>
<div class="MsoNormal" style="margin-left: 314.0pt; mso-list: l12 level8 lfo4; tab-stops: list 63.0pt; text-indent: -278.0pt;">
<b><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b>Nyeri dan gatal b/ d lesi kulit.</b></div>
<div class="MsoNormal" style="margin-left: 359.0pt; mso-list: l12 level9 lfo4; tab-stops: list 90.0pt; text-indent: -296.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Periksa daerah yang terlibat:</div>
<h4 style="margin-left: 117.0pt; tab-stops: list 117.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-weight: normal;">Upayakan untuk mnenemukan penyebab gangguan rasa
nyaman</span></h4>
<h4 style="margin-left: 117.0pt; tab-stops: list 117.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-weight: normal;">Mencatat hasik obervasi secra rinci dengan memekai
terminology deskriptif.</span></h4>
<h4 style="margin-left: 117.0pt; tab-stops: list 117.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-weight: normal; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-weight: normal;">Mengantisipasi Reaksi alergi yang mungkin terjadi.</span></h4>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 99.0pt; mso-list: l5 level1 lfo9; tab-stops: list 90.0pt; text-indent: -36.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kendalikan faktor – faktor iritan:</div>
<div class="MsoNormal" style="margin-left: 63.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l10 level1 lfo8; tab-stops: list 90.0pt 117.0pt left 288.0pt 315.0pt; text-indent: -27.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Perthankan kelembaban<span style="mso-spacerun: yes;"> </span>kira- kira 50 % gunakbn alat pelembab.</div>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l10 level6 lfo8; tab-stops: list 90.0pt left 117.0pt list 306.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pertahankan lingkungan yang dingin.</div>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l10 level6 lfo8; tab-stops: list 90.0pt left 117.0pt list 306.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Gunakan sabun ringan </div>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l10 level6 lfo8; tab-stops: list 90.0pt left 117.0pt list 306.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Lepaskan kelebihan pakaian dan peralatan
ditempat tidur.</div>
<div class="MsoNormal" style="margin-left: 117.0pt; mso-list: l10 level6 lfo8; tab-stops: 90.0pt 117.0pt list 306.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hentikan pemajanan berulang terhadap deterjen
pembersih dan pelarut.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; tab-stops: 90.0pt 117.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 63.0pt; mso-list: l11 level1 lfo10; tab-stops: list 63.0pt; text-indent: -27.0pt;">
<b><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b>Gangguan citra tubuh b/d penampakan kulit yang
tidak baik.</b></div>
<div class="MsoNormal" style="margin-left: 72.0pt; text-indent: -36.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l11 level4 lfo10; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji adanya gangguan citra tubuh</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l11 level4 lfo10; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Identifikaasi stadium psikososial tahap perkembangan</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l11 level4 lfo10; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan kesempatan untuk pengungkapan.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l11 level4 lfo10; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Beikan support pada klien untuk mengenal dirinya dan
mengembangkan dan memperbaiki citra diri.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l11 level4 lfo10; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Membantu klien kearah penerimaan diri.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l11 level4 lfo10; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mendorong sosialisasi dengan orang lain.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l11 level4 lfo10; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberikan nasehat kepada klien mengenai cra – cara
perawatan kosmetik untuk menyembunyikan kondisi kulit yang abnormal.</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<b>d.<span style="mso-tab-count: 1;"> </span>Kurang pengetahuan tentang perawatan kulit</b>.</div>
<div class="MsoNormal" style="margin-left: 99.0pt; mso-list: l0 level4 lfo3; tab-stops: list 99.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tentukan<span style="mso-spacerun: yes;"> </span>apakah
pasien mengetahui tentang kondisi dirinya.</div>
<div class="MsoNormal" style="margin-left: 99.0pt; mso-list: l0 level4 lfo3; tab-stops: list 99.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Jaga agar klien mendapatkan informasi yang benar
memperbaiki kesl;ahanperepsi.</div>
<div class="MsoNormal" style="margin-left: 99.0pt; mso-list: l0 level4 lfo3; tab-stops: list 99.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>peragaan penerapan terapi yan diprogramkan.</div>
<div class="MsoNormal" style="margin-left: 99.0pt; mso-list: l0 level4 lfo3; tab-stops: list 99.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan nasehat kapada pasien untuk menjaga agar kulit
tetap lembab dan fleksibel dengan tindakan hidarsi dan pengolesan krim serta
losionkulit.</div>
<div class="MsoNormal" style="margin-left: 99.0pt; mso-list: l0 level4 lfo3; tab-stops: list 99.0pt; text-indent: -27.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Dorong pasien untuk mendapatkan status nutrisi yang
sehat.</div>
<h4 style="margin-left: 198.0pt; mso-list: l5 level5 lfo9; text-indent: -198.0pt;">
<span style="mso-list: Ignore;">V.<span style="font: 7.0pt "Times New Roman";">
</span></span>Evaluasi.</h4>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<b>Hasil yang diharapkan :</b></div>
<div class="MsoNormal" style="margin-left: 72.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 71.0pt; mso-list: l4 level2 lfo6; tab-stops: list 63.0pt; text-indent: -35.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemeliharaan / mempertahankan integriras kulit.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l4 level3 lfo6; tab-stops: list 90.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>menunjukan tidak adanya keretakan kulit.</div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l4 level3 lfo6; tab-stops: list 90.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Melindungi kulit terhadap kontak dengan substansi yang
iritatif.</div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l4 level3 lfo6; tab-stops: list 90.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengoleskan preparat emolien pada kulit</div>
<div class="MsoNormal" style="margin-left: 71.0pt; mso-list: l4 level2 lfo6; tab-stops: list 63.0pt; text-indent: -35.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memenuhi kebutuhan rasa aman dan nyaman.</div>
<div class="MsoBodyTextIndent2" style="margin-left: 90.0pt; mso-list: l3 level2 lfo11; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Menggunakan preparat topical dan menjalani
terapi yang telah diprogramkan.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l3 level2 lfo11; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Melaporkan
peredaran rasa gatal.</div>
<div class="MsoNormal" style="margin-left: 71.0pt; text-indent: -8.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 71.0pt; mso-list: l4 level2 lfo6; tab-stops: list 63.0pt; text-indent: -35.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>memperlihatkan Pengembangan peningkatan penerimaan
diri;</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l4 level3 lfo6; tab-stops: list 90.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>lebuh sedikit mengucapkan kata – kata yang mencela
diri.</div>
<div class="MsoNormal" style="margin-left: 108.0pt; mso-list: l4 level3 lfo6; tab-stops: list 90.0pt; text-indent: -45.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberikan perhatian terhadap penampakan diri.</div>
<div class="MsoNormal" style="margin-left: 71.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 71.0pt; mso-list: l4 level2 lfo6; tab-stops: list 63.0pt; text-indent: -35.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>mencapai tidur yang lebih nyenyak.</div>
<div class="MsoNormal" style="margin-left: 71.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l9 level2 lfo12; tab-stops: list 90.0pt; text-indent: -9.0pt;">
<span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Menyatakan
bahwa tidur lebih nyenyak.</div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l9 level2 lfo12; tab-stops: list 90.0pt; text-indent: -9.0pt;">
<span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Melaporkan
bahwa hidup lebih sehat.</div>
<div class="MsoNormal" style="tab-stops: list 90.0pt; text-indent: -9.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 71.0pt; mso-list: l4 level2 lfo6; tab-stops: list 63.0pt; text-indent: -35.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemahaman tentang perwatan diri.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 90.0pt; mso-list: l8 level3 lfo13; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mengucapkan dengan kata – kata dasar pemikiran
untuk terapi yang diprogramkan.</div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l8 level3 lfo13; tab-stops: list 90.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Memperlhatkan kemampuan untuk melaksanakan
perawatan diri.</div>
<div class="MsoNormal" style="margin-left: 108.0pt; text-indent: 9.0pt;">
<br /></div>
<div class="MsoNormal">
<span style="mso-tab-count: 1;"> </span><b>Criteria
diagnosis Dermatitis Atopik dari hanifin dan rajka</b></div>
<div class="MsoNormal">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 22.1pt;" valign="top" width="29">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>No</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Criteria moyor</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Criteria minor</b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 22.1pt;" valign="top" width="29">
<div class="MsoNormal">
1.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div class="MsoNormal">
Pruritus </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div class="MsoNormal">
Kulit kering ( xerosis ).</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 22.1pt;" valign="top" width="29">
<div class="MsoNormal">
2.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div class="MsoNormal">
Adanya riwayat atopik</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div class="MsoNormal">
Keratosis </div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 22.1pt;" valign="top" width="29">
<div class="MsoNormal">
3.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div class="MsoNormal">
Kronis dan sering kambuh</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div class="MsoNormal">
Reaktivits uji kulit tipe I </div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 22.1pt;" valign="top" width="29">
<div class="MsoNormal">
4.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div class="MsoNormal">
Klinis dan distribusi yang khas:</div>
<div class="MsoNormal">
Lipatan kulit mengalami likenifikasi.</div>
<div class="MsoNormal">
Mengenai muka dan bagian extensor pada bayi dan anak –
anak.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 210.35pt;" valign="top" width="280">
<div class="MsoNormal">
Kadar Ig E meningkat.( > 2000 IU ).</div>
<div class="MsoNormal">
Dimulai pada usia dini.( 3 – 6 bulan ).</div>
<div class="MsoNormal">
Terdapat infeksi kulit.</div>
<div class="MsoNormal">
Eksema pada putting susu</div>
<div class="MsoNormal">
Cheilitis , konjungtivitis yang berulang – ulang,<span style="mso-spacerun: yes;"> </span>dll.</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<h1 align="center" style="text-align: center;">
Criteria diagnosis Dermatitis Atopik
dari Svennson</h1>
<div class="MsoNormal">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34">
<div class="MsoNormal">
<b>No</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 321.9pt;" valign="top" width="429">
<div class="MsoNormal">
<b>Kelompok I (nilai 3 ).</b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34">
<div class="MsoNormal">
1.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 321.9pt;" valign="top" width="429">
<div class="MsoNormal">
Perjalanan penyakit dipengaruhi musim</div>
<div class="MsoNormal">
Xerosis.</div>
<div class="MsoNormal">
Diperburuk dengan kegangan jiwa.</div>
<div class="MsoNormal">
Kulit sangat kering.</div>
<div class="MsoNormal">
Gatal pada kulit yang sehat saat berkeringat.</div>
<div class="MsoNormal">
Serum Ig E 80 IU /ml.</div>
<div class="MsoNormal">
Menderita rinitis alergik.</div>
<div class="MsoNormal">
Iritasi dengan tekstil.</div>
<div class="MsoNormal">
Eksema pada tangan pada masa kanak- kanak.dermatitis
atopik.</div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34">
<div class="MsoNormal">
2.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 321.9pt;" valign="top" width="429">
<div class="MsoNormal">
<b>Kelompok II ( nilai 2 ).</b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34">
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 321.9pt;" valign="top" width="429">
<div class="MsoNormal">
Kulit muka pucat</div>
<div class="MsoNormal">
Dermatitis pada buku jari2x tangan.</div>
<div class="MsoNormal">
Dermatitis nnumuler.</div>
<div class="MsoNormal">
Penderita punya asma, keratosis, alergi thd makanan,.</div>
<div class="MsoNormal">
Eksema putting susu.</div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34">
<div class="MsoNormal">
3.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 321.9pt;" valign="top" width="429">
<div class="MsoNormal">
<b>Kelompok III ( nilai 1 ).</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.5pt;" valign="top" width="34">
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 321.9pt;" valign="top" width="429">
<div class="MsoNormal">
Pomfolik </div>
<div class="MsoNormal">
Iktiosis </div>
<div class="MsoNormal">
Lipatan denni – morga.</div>
</td>
</tr>
</tbody></table>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Criteria diagnosis
Dermatitis Atopik dari</b> <b>William</b></div>
<div class="MsoNormal">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 167.4pt;" valign="top" width="223">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Criteria</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 221.4pt;" valign="top" width="295">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Keterangan</b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 167.4pt;" valign="top" width="223">
<div class="MsoNormal">
Harus ada : </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 221.4pt;" valign="top" width="295">
<div class="MsoNormal">
Rasa gatal( pada anak ada bekas garutan ).</div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 167.4pt;" valign="top" width="223">
<div class="MsoNormal">
Ditambah tiga / lebih</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 221.4pt;" valign="top" width="295">
<div class="MsoNormal">
Terkena daerah lipatan siku, paha, lutut, didepan mata
kaki, sekitar leher,pada pipi untuk anak dibawah 10 tahun).</div>
<div class="MsoNormal">
Anamnesis ada riwayat atropi, asma, demam.</div>
<div class="MsoNormal">
Kulit kering secara menyeluruh.</div>
<div class="MsoNormal">
Eksema pada lipatan ( termasuk pipi, kening badan luar
[pada anak .< 4 tahun).</div>
<div class="MsoNormal">
Mengenai umur <2 tidak digunakan untuk anak
dibawah<span style="mso-spacerun: yes;"> </span>tahun.</div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="margin-left: 54.0pt; text-indent: -36.0pt;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 54.0pt; text-align: center; text-indent: -36.0pt;">
<br /></div>
<h2>
Tingkatan dermatitis atopik</h2>
<div class="MsoNormal" style="margin-left: 54.0pt; text-indent: -36.0pt;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 54.0pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>No.</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Criteria</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Nilai</b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
1.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
Luasnya kelainan kulit.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
Fase anak – anak dan dewasa / remaja</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
< 9 % luas tubuh</div>
<div class="MsoNormal">
9 %<span style="mso-spacerun: yes;"> </span>- 36 % </div>
<div class="MsoNormal">
> 36 % luas tubuh.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
1</div>
<div class="MsoNormal">
2</div>
<div class="MsoNormal">
3</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
2.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
Fase infantile</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
18 % luas tubuh terkena </div>
<div class="MsoNormal">
18 % - 54 % </div>
<div class="MsoNormal">
54 % luas tubuh terkena.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
1</div>
<div class="MsoNormal">
2</div>
<div class="MsoNormal">
3</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
3.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
Perjalanan penyakit </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
Remisi > 3 bulan dalam 1 tahun</div>
<div class="MsoNormal">
Remisi < 3 bulan dalam 1 tahun</div>
<div class="MsoNormal">
Kambuhan</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
1</div>
<div class="MsoNormal">
2</div>
<div class="MsoNormal">
3</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
4.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
Intensitas penyakit.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.5pt;" valign="top" width="38">
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 246.9pt;" valign="top" width="329">
<div class="MsoNormal">
Gatal ringan kadang – kadang terganggu tidur.</div>
<div class="MsoNormal">
Gatal sedang </div>
<div class="MsoNormal">
Gatal hebat selalu ganggu tidur.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoNormal">
1</div>
<div class="MsoNormal">
2</div>
<div class="MsoNormal">
3</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 144.0pt; text-indent: -36.0pt;">
Penilaian : </div>
<div class="MsoNormal" style="margin-left: 144.0pt; text-indent: -36.0pt;">
3 – 4<span style="mso-tab-count: 2;"> </span>: Ringan</div>
<div class="MsoNormal" style="margin-left: 144.0pt; text-indent: -36.0pt;">
4,5 – 7,5 <span style="mso-tab-count: 1;"> </span>: Sedang<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal" style="margin-left: 144.0pt; text-indent: -36.0pt;">
8,5 – 9 <span style="mso-tab-count: 1;"> </span>: Berat </div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-indent: -36.0pt;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 54.0pt; text-align: center; text-indent: -36.0pt;">
<b>Stadium Exzema / Dermatitis.</b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-indent: -36.0pt;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>No</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Stadium</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 169.2pt;" valign="top" width="226">
<div align="center" class="MsoNormal" style="text-align: center;">
<b>Pengobatan</b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
1.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302">
<div class="MsoNormal">
Akut<span style="mso-spacerun: yes;"> </span>( ada
vesikula, edema, eksudasi, krusta,, erosi ) </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 169.2pt;" valign="top" width="226">
<div class="MsoNormal">
Kompres da krim hyrofilik.</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
2.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302">
<div class="MsoNormal">
Subakut ( eritema, edema, papula, skuama yang basah ).</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 169.2pt;" valign="top" width="226">
<div class="MsoNormal">
Krim anti flogistik, pasta yang lembut.</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
3.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302">
<div class="MsoNormal">
Kronik ( deskuamasi yg kering, likenifikasi, infiltrat
paula. )</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 169.2pt;" valign="top" width="226">
<div class="MsoNormal">
Salap hydro s/d lipofilik.</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
4.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302">
<div class="MsoNormal">
Hyperkeratosis </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 169.2pt;" valign="top" width="226">
<div class="MsoNormal">
Keratofilik, salap rehidrasi yang mnegandung asam salisil,
urea, Nacl 4 – 12 jam tertutup.</div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
5.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302">
<div class="MsoNormal">
Eksudasi , lesi maserasi.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 169.2pt;" valign="top" width="226">
<div class="MsoNormal">
Keringkan dengan kompres yg mengandung air/ alkohol,
/pasta.</div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
5.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302">
<div class="MsoNormal">
Semua stadium </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 169.2pt;" valign="top" width="226">
<div class="MsoNormal">
Mandi berendam.</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<h1>
Tipe – tipe preparat kortikosteroid topical yang sering digunakan.m</h1>
<div class="MsoNormal">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
No </div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.0pt;" valign="top" width="192">
<div class="MsoNormal">
Potensi </div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div class="MsoNormal">
Preparat kortikosteroid.</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
1.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.0pt;" valign="top" width="192">
<div class="MsoNormal">
Paling rendah </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div class="MsoNormal">
Deksametason 0.1%</div>
<div class="MsoNormal">
Hirokortison 0.25 – 2.5 %</div>
<div class="MsoNormal">
Metilprednisolon<span style="mso-spacerun: yes;">
</span>0.1/1 %</div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
2.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.0pt;" valign="top" width="192">
<div class="MsoNormal">
Rendah </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div class="MsoNormal">
Betametason 0.01 %</div>
<div class="MsoNormal">
Klokortolon / cloderm 0.1 %</div>
<div class="MsoNormal">
Hidrokortison valerat 0.2 %</div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
3.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.0pt;" valign="top" width="192">
<div class="MsoNormal">
Sedang </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div class="MsoNormal">
Betametason benzoat 0.01%</div>
<div class="MsoNormal">
Cordran 0.05 %</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
4.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.0pt;" valign="top" width="192">
<div class="MsoNormal">
Tinggi </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div class="MsoNormal">
Amsinonid / cyclokort<span style="mso-spacerun: yes;">
</span>0.1 %</div>
<div class="MsoNormal">
Halog 0.1 %</div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 32.4pt;" valign="top" width="43">
<div class="MsoNormal">
5.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.0pt;" valign="top" width="192">
<div class="MsoNormal">
Paling tinggi </div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 171.0pt;" valign="top" width="228">
<div class="MsoNormal">
Betametason dipropionat 0.05 %</div>
<div class="MsoNormal">
Klobetasol propionat 0.05%</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
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<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-31409319879446848202011-11-10T07:31:00.001-08:002011-11-10T07:32:28.061-08:00<!--[if !mso]>
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<h1 align="center" style="text-align: center;">
<b><span style="font-size: 16.0pt; mso-bidi-font-size: 10.0pt;">ASUHAN KEPERAWATAN</span></b></h1>
<h1 align="center" style="text-align: center;">
<b><span style="font-size: 16.0pt; mso-bidi-font-size: 10.0pt;">PADA KLIEN DENGAN EPILEPSI</span><span style="font-size: 16.0pt; font-weight: normal; mso-bidi-font-size: 10.0pt;"></span></b></h1>
<h1>
<b><span style="font-size: 16.0pt; mso-bidi-font-size: 10.0pt;"> </span></b></h1>
<h1>
<b><span style="mso-spacerun: yes;"> </span>A.<span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span>Pendahuluan</b></h1>
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<h3 style="line-height: 200%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<b>Epilepsi merupakan penyakit tertua di dunia (2000 th SM) (Petrus Tjahyadi
dikutif dari Harsono,Ed : 1996). Di Indonesia kasus epilepsi secara pasti tidak
diketahui karena tidak ada data epidemiologi, namum hingga saat ini
diperkirakan ada 900.000 sampai 1.800.000 kasus (Petrus Tjahyadi dikutif dari
Harsono,ED : 1996).Penyakit epilepsi selain merupakan masalah kesehatan yang
sangat rumit juga merupakan suatu penyakit yang menimbulkan dampak / stigma
sosial yang sangat berat bagi penderita dan keluarganya. Adanya pemahaman yang
salah tentang penyakit epilepsi yang dipandang sebagai penyakit kutukan
merupakan suatu hal yang menyebabkab sulitnya mendeteksi jumlah kasus ini di
masyarakat karena biasanya keluarga sering menyembunyikan keluarganya yang
menderita penyakit ini.</b></h3>
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<b>Penanganan
terhadap penyakit ini bukan saja menyangkut penanganan medikamentosa dan
perawatan belaka, namun yang lebih penting adalah bagaimana
meminimalisasikan<span style="mso-spacerun: yes;"> </span>dampak yang muncul
akibat penyakit ini bagi penderita dan keluarga maupun merubah stigma
masyarakat tentang penderita epilepsi.</b></div>
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<b>Pada dasarnya epilepsi merupakan suatu penyakit
Susunan Saraf Pusat (SSP) yang timbul akibat adanya ketidak seimbangan
polarisasi listrik di otak. Ketidak seimbangan polarisasi listrik tersebut
terjadi akibat adanya fokus-fokus iritatif pada neuron sehingga menimbulkan
letupan muatan listrik spontan yang berlebihan dari sebagian atau seluruh
daerah yang ada di dalam otak.</b></div>
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<b>Masalah yang muncul adalah bagaimana hal tersebut
bisa muncul, bagaimana manifestasinya dan bagaimana penanganan yang dapat
dilakukan untuk kasus ini masih memerlukan kajian yang lebih mendalam.</b></div>
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<b>B.<span style="mso-tab-count: 1;"> </span>Deskripsi
Penyakit</b></h1>
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<b>Epilepsi
terjadi akibat adanya kerusakan membran pada sel glia otak. Sel glia merupakan
bagian dari sel otak yang multi fungsi. Salah satu fungsi penting dari sel glia
bila dikaitkan dengan penyakit epilepsi ini adalah fungsi sel glia sebagai
pensuplai nutrisi dan reservoar dari elektrolit seperti ion K, Ca dan Na.
Ketidak seimbangan pada sel ini akan menyebabkan permasalahan pada sel syaraf.
Proses epileptogenik akan terjadi bila ada pelepasan muatan paroksiman karena
mekanisme intrinsik dari membran neuron yang menjaga kestabilan ambang lepas
muatan terganggu sehingga bisa terjadi depolarisasi secara terus menerus yang
selanjutnya menyebabkan timbulnya letupan potensial aksi (paroksismal
depolarisasi shif).</b></div>
<div class="MsoBodyTextIndent3">
<b><span style="height: 31px; left: 0px; margin-left: 210px; margin-top: 253px; mso-ignore: vglayout; position: absolute; width: 185px; z-index: 251651584;"><img height="31" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="185" /></span>Penyebab dan proses secara jelas
terjadinya epileptogenik hingga saat ini belum begitu jelas. Namun sebagian
besar dipengaruhi oleh beberapa faktor seperti adanya trauma kelahiran,
infeksi, gangguan sirkulasi, gangguan metabolisme, tumor otak, trauma kepala
dan penyakit-penyakit saat kehamilan (epilepsi simtomatis). Namun beberapa
jenis epilepsi tidak diketahui dengan jelas penyebabnya dan diduga karena
faktor genetik (epilepsi idiopatik). Proses sederhana terjadinya fokus
epileptik dapat dilihat pada bagan di bawah.</b></div>
<h5 style="text-indent: 0cm;">
<b><span style="height: 32px; left: 0px; margin-left: 271px; margin-top: 24px; mso-ignore: vglayout; position: absolute; width: 60px; z-index: 251652608;"><img height="32" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="60" /></span><span style="font-size: 10.0pt; line-height: 200%;">KERUSAKAN JARINGAN</span></b></h5>
<div align="center" class="MsoNormal" style="line-height: 200%; text-align: center; text-indent: 36.0pt;">
<b><span style="mso-ignore: vglayout;">
</span></b></div>
<table align="left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td height="32" width="133"><br /></td>
</tr>
<tr>
<td><br /></td>
<td><img height="21" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="348" /></td>
</tr>
</tbody></table>
<b>
<span style="font-size: 12.0pt; line-height: 200%; mso-bidi-font-size: 10.0pt;"> </span></b><br />
<b>
</b><b><br clear="ALL" style="mso-ignore: vglayout;" />
</b><h4>
<b><span style="font-size: 10.0pt;">JARINGAN OTAK RUSAK / GANGGUAN METABOLISME</span></b></h4>
<div align="center" class="MsoNormal" style="line-height: 200%; text-align: center;">
<b><span style="mso-ignore: vglayout; position: relative; z-index: 251654656;"><span style="height: 60px; left: 0px; left: 162px; position: absolute; top: -1px; width: 290px;"><img height="60" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="290" /></span></span><span style="font-size: 12.0pt; line-height: 200%; mso-bidi-font-size: 10.0pt;"> </span></b></div>
<b>
</b><b><br clear="ALL" style="mso-ignore: vglayout;" />
</b><h4>
<b><span style="font-size: 10.0pt;">PENURUNAN FUNGSI RESERVOIR SEL GLIA</span></b></h4>
<div align="center" class="MsoNormal" style="line-height: 200%; text-align: center;">
<b><span style="mso-ignore: vglayout;">
</span></b></div>
<table align="left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td height="5" width="153"><br /></td>
</tr>
<tr>
<td><br /></td>
<td><img height="69" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="299" /></td>
</tr>
</tbody></table>
<b>
<span style="font-size: 12.0pt; line-height: 200%; mso-bidi-font-size: 10.0pt;"> </span></b><br />
<b>
</b><b><br clear="ALL" style="mso-ignore: vglayout;" />
</b><h4>
<b><span style="height: 97px; left: 0px; margin-left: 9px; margin-top: 7px; mso-ignore: vglayout; position: absolute; width: 70px; z-index: 251659776;"><img height="97" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image006.gif" width="70" /></span><span style="font-size: 10.0pt;">ION
KALIUM TIDAK MENDAPATKAN TEMPAT</span></b></h4>
<h4>
<b><span style="font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>YANG
TEPAT SAAT PEMBENTUKAN IMPULS</span></b></h4>
<div class="MsoNormal">
<b><span style="mso-spacerun: yes;"> </span></b></div>
<div class="MsoNormal">
<b><span style="mso-ignore: vglayout;">
</span></b></div>
<table align="left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td height="8" width="105"><br /></td>
<td width="165"><br /></td>
<td width="7"><br /></td>
<td width="51"><br /></td>
<td width="7"><br /></td>
<td width="127"><br /></td>
<td width="26"><br /></td>
<td width="79"><br /></td>
</tr>
<tr>
<td height="3"><br /></td>
<td align="left" rowspan="3" valign="top"><img height="41" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image007.gif" width="165" /></td>
<td colspan="3"><br /></td>
<td align="left" rowspan="3" valign="top"><img height="41" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image008.gif" width="127" /></td>
</tr>
<tr>
<td height="1"><br /></td>
<td><br /></td>
<td align="left" rowspan="3" valign="top"><img height="42" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image009.gif" width="51" /></td>
</tr>
<tr>
<td height="37"><br /></td>
<td><br /></td>
<td><br /></td>
<td><br /></td>
<td align="left" rowspan="3" valign="top"><img height="125" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image010.gif" width="79" /></td>
</tr>
<tr>
<td height="4"><br /></td>
</tr>
<tr>
<td height="84"><br /></td>
</tr>
</tbody></table>
<b>
</b><br />
<b>
</b><b><br clear="ALL" style="mso-ignore: vglayout;" />
</b><div class="MsoNormal">
<b><span style="mso-spacerun: yes;"> </span>ION K
TERKUMPUL PADA<span style="mso-spacerun: yes;">
</span>KRISIS MUATAN</b></div>
<h3>
<b><span style="font-size: 10.0pt;"><span style="mso-spacerun: yes;">
</span>DINDING NEURON<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>LISTRIK</span></b></h3>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="height: 31px; margin-left: 133px; margin-top: 8px; mso-ignore: vglayout; position: absolute; width: 319px; z-index: 251662848;"><img height="31" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image011.gif" width="319" /></span><span style="mso-tab-count: 3;"> </span></b></div>
<div class="MsoNormal" style="margin-left: 72.0pt; text-indent: 36.0pt;">
<b>AKTIVITAS
SARAF SPONTAN TAK TERKONTROL</b></div>
<div class="MsoBodyTextIndent">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; text-align: justify;">
<b>Dari
skema di atas dapat ditarik suatu analisa bahwa jika terjadi suatu gangguan
polarisasi listrik pada otak akan menyebabkan efek terhadap aktivitas dari
saraf secara spontan yang dimanifestasikan dengan adanya gerakan-gerakan yang
abnormal pada organ-organ tubuh penderita. Keadaan ini dapat menyebabkan
penurunan kontrol dan kesadaran sehingga dapat<span style="mso-spacerun: yes;">
</span>menimbulkan dampak berupa kemungkinan trauma / cedera fisik bagi
penderita yang sedang mengalami serangan.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; text-align: justify;">
<b>Berdasarkan
hasil EEG dan gejala yang ditemukan, epilepsi dapat diklasifikasikan menjadi
beberapa jenis yaitu <span style="mso-no-proof: yes;">: (Kariasa,Md, FIK UI,
1997)</span></b></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l12 level1 lfo1; tab-stops: list 0cm; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Kejang umum</b><b>
: </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; text-align: justify;">
<b>Kejang
yang menunjukkan sinkronisasi keterlibatan semua bagian otak pada kedua
hemisfer. Otak teraktivasi secara bersama tanpa awitan fokal, sinkron, tanpa
didahului oleh prodormal dan aura. Yangdigolongkan dalam jenis ini adalah petit
mall, grand mall, mioklonik dan atonik. </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; text-align: justify; text-indent: -36.0pt;">
<b>a.<span style="mso-tab-count: 1;"> </span>Petit mall
: muncul setelah usia 4 tahun, pasien kehilangan kesadaran sesaat seperti
bengong tanpa disertai gerakan involunter yang aneh. Bila hal ini berlangsung
terus dapat berakibat buruk pada alur belajar terutama anak-anak yang sedang
belajar. Anak akan menjadi malu sehingga anak akan mengalami gangguan dalam
prestasi belajar.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l9 level1 lfo16; tab-stops: list 36.0pt; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Grand mall / kejang tonik-klonik : yakni adanya
serangan kejang ekstensi tonik-klonik bilateral ekstremitas. Kadang disertai
dengan adanya inkontinensia urine atau feces, menggigit lidah, mulut berbusa
dan kehilangan kesadaran yang mendadak yang diikuti gejala-gejala post iktal
seperti nyeri otot, lemah dan letih, bingung serta tidur dalam waktu lama.</b></div>
<div class="MsoBodyTextIndent" style="text-align: justify; text-indent: 0cm;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l12 level1 lfo1; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Kejang
parsial</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 1.0cm; text-align: justify;">
<b>Kejang yang didahului dengan adanya<span style="mso-spacerun: yes;"> </span>awitan fokal yang melibatkan satu bagian
tertentu dari otak. </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l3 level1 lfo2; tab-stops: list 0cm; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Kejang
parsial sederhana : sering disebut epilepsi Jakson, dimana pada kelompok ini
akan terjadi kejang secara involunter yang bersifat unilateral tanpa diikuti
oleh adanya perburukan.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l3 level1 lfo2; tab-stops: list 0cm; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Kejang
parsial kompleks : sering disebut dengan kejang lobus temporal, psikomotor atau
otomatisme yang fokalnya sering berpusat pada lobus temporalis. Sering pada
kejang parsial sering diikuti oleh gangguan kesadaran semacam gangguan proses
pikir. Gejala dapat berupa halusinasi, mual dan berkeringat sebagai prodormal.
Pasien yang sedang mengalami serangan ini sering menunjukkan perilaku bersifat
agitatif dan kombatif.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; text-align: justify;">
<b>Bila
dikaitkan dengan kelompok usia yang terpapar, epilepsi dapat digolongkan
menjadi beberapa jenis (Harsono.ED.1996) :</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l14 level1 lfo3; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Kelompok
Usia 0 – 6 bulan</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l8 level1 lfo4; tab-stops: 35.45pt list 75.0pt; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kelainan intra uterin, yang menyebabkan gangguan
migrasi dan diferensiasi sel neuron. Hal ini juga bisa dipengaruhi oleh infeksi
intra uterin.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l8 level1 lfo4; tab-stops: 35.45pt list 75.0pt; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kelainan selama kehamilan misal asfeksia, dan
perdarahan intra uterin yang didahului oleh kelainan maternal seperti : hipotensi,
eklamsia, disproporsi sefalopelvik, kelainan plasenta, tali pusat menumbung
atau belitan tali pusat pada leher.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l8 level1 lfo4; tab-stops: 35.45pt list 75.0pt; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kelainan kongenital seperti kromosom abnormal, radiasi
obat teratogenik, infeksi intra partum oleh toksoplasma, sitomegalo virus,
rubela dan treponema.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l8 level1 lfo4; tab-stops: 35.45pt list 75.0pt; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan metabolik seperti hipoglikemi, hipokalsemi,
hiponatremia, dan defisiensi piridoksin. </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l8 level1 lfo4; tab-stops: 35.45pt list 75.0pt; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Infeksi Susunan Saraf Pusat seperti meningitis,
ensefalitis, dan hidrosefalus pasca infeksi.</b></div>
<div class="MsoBodyTextIndent" style="tab-stops: 35.45pt; text-align: justify; text-indent: 0cm;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l14 level1 lfo3; tab-stops: -4.5pt 0cm; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Kelompok 6 bulan
– 3 tahun</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 4.5pt; text-align: justify;">
<b>Selain oleh penyebab yang sama dari kelompok di atas pada umur
ini dapatjuga disebabkan oleh adanya kejang demam yang biasanya dimulai pada
umur 6 bulan. Faktor lain yang mempengaruhi adalah adanya cedera kepala.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l14 level1 lfo3; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Kelompok
anak-anak sampai remaja</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 35.45pt 2.0cm; text-align: justify;">
<b>Dapat disebabkan oleh Infeksi virus, bakteri, parasit
dan abses otak yang frekuensinya meningkat sampai 23%, setelah tindakan
operasi.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l14 level1 lfo3; tab-stops: 0cm; text-align: justify; text-indent: .75pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Kelompok
usia muda</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 0cm; text-align: justify;">
<b><span style="mso-tab-count: 1;"> </span>. Tersering
karena cedera kepala, tumor otak <span style="mso-tab-count: 1;"> </span>dan
infeksi.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l14 level1 lfo3; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Kelompok
usia lanjur</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 0cm 4.5pt; text-align: justify;">
<b>Karena gangguan pembuluh darah otak, diikuti oleh trauma dan
degenerasi cerebral.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 0cm 4.5pt; text-align: justify;">
<b>Jika terjadi serentetan serangan epilepsi jenis grand mall
tanpa diselingi dengan pemulihan status neurologi disebut dengan status
epileptikus. Yang dijadikan patokan adalah kejang secara klinis atau pada EEG
tampak adanya gambaran eksitasi abnormal selama 30 menit atau lebih. Hal ini
akan berbahaya jika diikuti oleh adanya <i style="mso-bidi-font-style: normal;"><u>hipoksia
jaringan otak, gagal pernafasan, hipertensi, peningkatan tekanan intra kranial.</u></i>
Keadaan ini membutuhkan perawatan yang intensif. Penurunan kesadaran dapat
berakibat terjadinya <i style="mso-bidi-font-style: normal;"><u>ancaman berupa
sumbatan jalan nafas. </u></i>Kejadian yang terjadi secara terus menerus dapat
menimbulkan dampak yang<i style="mso-bidi-font-style: normal;"><u> sangat buruk
terhadap perkembangan psiko-sosial dari klien maupun keluarganya, berupa rasa
malu, harga diri yang rendah serta penurunan terhadap gambaran diri.</u></i>
Hal ini akan menyebabkan efek samping pada penurunan prestasi belajar terutama
bagi penderita yang masih dalam masa belajar.</b></div>
<div class="MsoBodyTextIndent" style="tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l0 level1 lfo5; tab-stops: list 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 200%; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 200%; mso-bidi-font-size: 10.0pt;"><span style="mso-spacerun: yes;"> </span>Pengkajian</span></b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 200%; mso-bidi-font-size: 10.0pt;"><span style="mso-tab-count: 2;"> </span></span></b><b><span style="mso-tab-count: 1;"> </span>Pengkajian dilakukan secara
komprehensif dengan berbagai metode pengkajian seperti anamnesa, observasi,
pengukuran, dokumentasi dan pemeriksaan fisik. Metode pengkajian yang digunakan
untuk mengoptimalkan hasil yang diperoleh meliputi beberapa cara diantaranya
head to toe, teknik persistem, maupun berdasarkan atas kebutuhan dasar manusia.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l7 level1 lfo6; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Identitas
klien dan penanggungjawab</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 35.45pt 2.0cm; text-align: justify;">
<b>Pengkajian yang dilakukan meliputi identitas klien dan
penanggungjawabnya.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.0pt; tab-stops: 35.45pt 2.0cm; text-align: justify; text-indent: 35.45pt;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l7 level1 lfo6; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Keluhan
Utama</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 35.45pt 2.0cm; text-align: justify;">
<b>Untuk keluhan utama, pasien atau keluarga biasanya
ketempat pelayanan kesehatan karena klien yang mengalami penurunan kesadaran
secara tiba-tiba disertai mulut berbuih. Kadang-kadang klien / keluarga
mengeluh anaknya prestasinya tidak baik dan sering tidak mencatat. Klien atau
keluarga mengeluh anaknya atau anggota keluarganya sering berhenti mendadak
bila diajak bicara</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 2.0cm; tab-stops: 35.45pt 2.0cm; text-align: justify; text-indent: 35.45pt;">
<b>.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l7 level1 lfo6; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Riwayat
Penyakit</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 35.45pt; text-align: justify;">
<b>Fokus pengkajian yang dilakukan adalah pada riwayat
kesehatan dan pemeriksaan fisik. Ini dapat dimengerti karena riwayat kesehatan
terutama berhubungan dengan kejang sangat membantu dalam menentukan diagnosa.
Riwayat ini akan dirunjang dengan keadaan fisik klien saat ini. Pemeriksaan
neurologi terutama berkaitan dengan serangan kejang harus lengkap karena
temuan-temuan fokal sangat membantu dalam menentukan asal dari aktivitas
kejang. Pada riwayat perlu dikaji faktor pencetus yang dapat diidentifikasikan
hingga saat ini adalah : demam, cedera kepala, stroke, gangguan tidur,
penggunaan obat, kelemahan fisik, hiperventilasi, dan stress emosional.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 35.45pt; text-align: justify;">
<b>Deskripsispesifik dari kejang harus mencakup beberapa data
penting meliputi :</b></div>
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<b><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Awitan yakni serangan itu mendadak atau didahului oleh
prodormal dan fase aura.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l4 level1 lfo7; tab-stops: 35.45pt list 74.7pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Durasi kejang berapa lama dan berapa kali frekuensinya.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l4 level1 lfo7; tab-stops: 35.45pt list 74.7pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Aktivitas motorik mencakup apakah ekstrimitas yang
terkena sesisi atau bilateral, dimana mulainya dan bagaimana kemajuannya.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l4 level1 lfo7; tab-stops: 35.45pt list 74.7pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Status kesadaran dan nilai kesadarannya. Apakah klien
dapat dibangunkan selama atau setelah serangan ?</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l4 level1 lfo7; tab-stops: 35.45pt list 74.7pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Distrakbilitas, apakah klien dapat memberi respon
terhadap lingkungan. Hal ini sangat penting untuk membedakan apakah yang
terjadi pada klien benar epilepsi atau hanya reaksi konversi.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l4 level1 lfo7; tab-stops: 35.45pt list 74.7pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Keadaan gigi. Apakah pada saat serangan gigi klien
tertutup rapat atau terbuka.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l4 level1 lfo7; tab-stops: 35.45pt list 74.7pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Aktivitas tubuh seperti inkontinensia, muntah, salivasi
dan perdarahan dari mulut.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l4 level1 lfo7; tab-stops: 35.45pt list 74.7pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Masalah yang dialami setelah serangan paralisis,
kelemahan, baal atau semutan, disfagia, disfasia cedera komplikasi, periode
post iktal atau lupa terhadap semua pristiwa yang baru saja terjadi.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l4 level1 lfo7; tab-stops: 35.45pt list 74.7pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";">
</span></span>Faktor pencetus seperti stress emosional dan fisik.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 35.45pt; text-align: justify; text-indent: 0cm;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 0cm; mso-list: l7 level1 lfo6; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Data
Bio-psiko-sosial-spiritual</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 35.45pt 2.0cm; text-align: justify;">
<b>Data yang sudah dikaji sebelumnya dengan menggunakan
berbagai metode yang valid selanjutnya dikelompokkan secara umum menjadi data
subyektif dan obyektif.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l1 level1 lfo8; tab-stops: 36.0pt; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data Subyektif : adanya keluhan tentang faktor
pencetus, prodormal(pusing, lemas, ngantuk, halusinasi dll). Merasakan adanya
seperti tersambar petir (fase aural), mengeluh adanya gangguan proses pikir,
waham, badan nyeri, letih dan bingung. Klien merasa malu, tidak berguna, rendah
diri dan takut.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l1 level1 lfo8; tab-stops: 35.45pt 2.0cm list 75.0pt left 78.0pt; text-align: justify; text-indent: -36.0pt;">
<b><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data Obyektif : adanya gerakan tonik, klonik,
tonik-klonik, hilang kesadaran sesaat, hilang kesadaran beberapa lama, bibir
berbusa, sering diam beberapa saat bila sedang diajak bicara, gerakan
ekstrimitas terkedut bilateral, pasien terjatuh, kontraksi involunter
unilateral, kejang biasanya mulai dari tempat yang sama setiap serangan,
agresif, pupil mengalami perubahan ukuran selama serangan, inkontinensia,
perdarahan dari mulut, penurunan respon terhadap lingkungan, kejang terjadi
beberapa detik hingga beberapa menit. Gambaran EEG berupa gelombang spike,
spike and slow wave, poly spike and wave, 3 Hz spike and wave. MRI / CT SCAN
bisa tampak adanya massa di lobus otak.Perubahan yang bermakna tidak spesifik
pada tanda-tanda vital. Dapat terjadi perubahan tidak spesifik pada<span style="mso-tab-count: 1;"> </span>hasil laboratorium (Glukosa darah, <span style="mso-tab-count: 1;"> </span>BUN, Elektrolit, Pa O2, Pa CO2 termasuk
hasil fungsi lumbal).</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.0pt; tab-stops: 35.45pt 2.0cm 78.0pt; text-align: justify; text-indent: 0cm;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.0pt; mso-list: l7 level1 lfo6; tab-stops: 35.45pt list 57.0pt; text-align: justify; text-indent: -57.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Rencana
Asuhan Keperawatan</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 75.0pt; mso-list: l10 level1 lfo9; tab-stops: 35.45pt 2.0cm list 75.0pt; text-align: justify; text-indent: -39.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Diagnosa
Keperawatan</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 35.45pt 2.0cm 58.5pt; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-tab-count: 1;"> </span></b><b>Rencana Keperawatan
diawali dengan penyusunan diagnosa keperawatan. Diagnosa keperawatan yang biasa
muncul pada pasien yang mengalami epilepsi adalah </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l6 level1 lfo10; tab-stops: 2.0cm 70.9pt list 91.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";">
</span></span>Potensial kecelakaan s.d. penurunan kesadaran, kelemahan
fisik, gerak otot </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 2.0cm 70.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>tonik klonik.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l6 level1 lfo10; tab-stops: 2.0cm 70.9pt list 91.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";">
</span></span>Potensial terjadi sumbatan jalan nafas s.d. obstruksi
tracheo bronkhial, </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 2.0cm 70.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>gangguan persepsi dan neuro muskuler.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l6 level1 lfo10; tab-stops: 2.0cm 70.9pt list 91.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan konsep diri s.d. stigma sosial, salah persepsi
dari lingkungan sosial.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l6 level1 lfo10; tab-stops: 2.0cm 70.9pt list 91.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan mekanisme koping s.d. terdiagnose epilepsi dan
keterikatan dengan obat.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; mso-list: l6 level1 lfo10; tab-stops: 2.0cm 70.9pt list 91.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">5)<span style="font: 7.0pt "Times New Roman";">
</span></span>Kurangnya pengetahuan tentang penyakit dan
pengobatannya s.d. kurang </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 2.0cm 70.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>terbuka, mis interpretasi dan kurang interpretasi.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 36.0pt; tab-stops: 2.0cm 70.9pt; text-align: justify; text-indent: 0cm;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 75.0pt; mso-list: l10 level1 lfo9; tab-stops: 2.0cm 70.9pt list 75.0pt; text-align: justify; text-indent: -39.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Rencana
Keperawatan</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.6pt; tab-stops: 2.0cm 70.9pt; text-align: justify; text-indent: 0cm;">
<b>a.<span style="mso-tab-count: 1;"> </span>Potensial
kecelakaan sehubungandengan penurunan kesadaran,<span style="mso-spacerun: yes;"> </span></b></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.6pt; tab-stops: 2.0cm 70.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>kelemahan<span style="mso-spacerun: yes;"> </span>fisik, gerak otot tonik
klonik.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.6pt; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b>b. <span style="mso-tab-count: 1;"> </span>Potensial
terjadi sumbatan jalan nafas sehubungan dengan<span style="mso-spacerun: yes;"> </span>obstruksi </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.6pt; tab-stops: 0cm 72.0pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>tracheo<span style="mso-spacerun: yes;"> </span>bronkhial, gangguan
persepsi dan neuro muskuler.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 75.0pt; mso-list: l10 level1 lfo9; tab-stops: 2.0cm 70.9pt list 75.0pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan konsep diri sehubungan dengan stigma sosial,
salah persepsi </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.0pt; tab-stops: 2.0cm 70.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>dari lingkungan sosial.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 75.0pt; mso-list: l10 level1 lfo9; tab-stops: 2.0cm 70.9pt list 75.0pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan mekanisme koping (koping tidak efektif)
sehubungan</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 57.0pt; tab-stops: 2.0cm 70.9pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>dengan terdiagnose epilepsi dan keterikatan dengan obat.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 58.5pt; tab-stops: 72.0pt; text-align: justify; text-indent: 0cm;">
<b>e..<span style="mso-tab-count: 1;"> </span>Kurangnya
pengetahuan tentang penyakit (epilepsi) dan </b></div>
<div class="MsoBodyTextIndent" style="margin-left: 58.5pt; tab-stops: 72.0pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>pengobatannya<span style="mso-spacerun: yes;"> </span>sehubungan
dengan<span style="mso-spacerun: yes;"> </span>mis interpretasi dan kurang
informasi.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 35.25pt; mso-list: l14 level1 lfo3; tab-stops: list 35.25pt; text-align: justify; text-indent: -35.25pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Rencana
tindakan</b></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-layout-alt: fixed;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.9pt;" valign="top" width="37">
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;">NO </b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div align="center" class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 36.0pt 2.0cm; text-align: center; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;">Diagnosa</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.5pt;" valign="top" width="174">
<div align="center" class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: center; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;">Tujuan</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.6pt;" valign="top" width="357">
<div align="center" class="MsoBodyTextIndent" style="margin-left: -5.4pt; tab-stops: 36.0pt 2.0cm; text-align: center; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;">Implementasi</b></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.9pt;" valign="top" width="37">
<div class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b style="mso-bidi-font-weight: normal;">1.</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 36.0pt 2.0cm; text-indent: 0cm;">
<b>Dx<span style="mso-spacerun: yes;"> </span>1</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.5pt;" valign="top" width="174">
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 36.0pt 2.0cm; text-indent: 0cm;">
<b>Serangan dapat dikendalikan dan komplikasi dapat
dihindari</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.6pt;" valign="top" width="357">
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 10.35pt; text-align: justify; text-indent: 0cm;">
<b>1. Cegah dan kendalikan kejang</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 12.6pt; tab-stops: 10.35pt 12.6pt; text-indent: -12.6pt;">
<b>2. Hindarkan lingkungan agar
aman dari kemungkinan yang dapat menimbulkan cedera bagi klien</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; text-align: justify; text-indent: 0cm;">
<b>3. Siapkan spatel lidah di dekat klien</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b>4. Hindarkan klien sendirian</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b>5. Usahakan agar tempat tidur klien </b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>serendah mungkin</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 12.6pt; mso-list: l7 level1 lfo6; tab-stops: -5.4pt; text-indent: -12.6pt;">
<b><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span>Jangan pernah mengikat klien dengan</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 12.6pt; tab-stops: -5.4pt; text-indent: 0cm;">
<b>Alasan apapun </b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 12.6pt; mso-list: l7 level1 lfo6; tab-stops: list -5.4pt; text-align: justify; text-indent: -12.6pt;">
<b><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span>Jangan
memasukkan benda apapun kemulut klien </b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;">
</span>saat terjadi serangan</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b>8. Pasang gudel saat serangan berkurang</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: -.9pt; text-align: justify; text-indent: 0cm;">
<b>9. Miringkan klien pada salah satu sisi</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -5.4pt; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b>10. Obserpasi adanya
tanda-tanda status epileptikus</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -5.4pt; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b>11. Upayakan agar klien
mampu mengenali</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -5.4pt; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;"> </span>faktor<span style="mso-spacerun: yes;">
</span>pencetus </b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -5.4pt; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;"> </span>dan tanda-tanda serangan</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -5.4pt; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b>12. Lakukan tindakan
kolaborasi :</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 26.85pt; mso-list: l11 level1 lfo11; tab-stops: -5.4pt list 17.1pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">a.</span>
Pemberian obat anti konvulsan</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 21.6pt; mso-list: l11 level1 lfo11; tab-stops: -5.4pt; text-align: justify; text-indent: -13.5pt;">
<b><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span><span style="mso-spacerun: yes;"> </span>Siapkan klien untuk EEG, pengambilan bahan
lab elektrolit, cairan cerebro spinal, darah lengkap, BUN, Creatinin, Glukosa
darah, PO2 dan PCO2.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -5.4pt; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b>13. Observasi fase-fase
kejang </b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -5.4pt; tab-stops: -5.4pt; text-align: justify; text-indent: 0cm;">
<b>14. Analisa ambulasi
klien</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 0cm; text-align: justify; text-indent: 0cm;">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.9pt;" valign="top" width="37">
<div class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>2</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>Dx. 2</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.5pt;" valign="top" width="174">
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>Jalan nafas tetap paten</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.6pt;" valign="top" width="357">
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 12.6pt; mso-list: l15 level1 lfo12; tab-stops: list 0cm; text-align: justify; text-indent: -12.6pt;">
<b><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span>Anjurkan
agar klien mengosongkan mulut jika fase aura dapat dikenali</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 12.6pt; mso-list: l15 level1 lfo12; tab-stops: list 0cm; text-align: justify; text-indent: -12.6pt;">
<b><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span>Buat
klien dalam posisi miring pada salah satu sisi untuk menghindari adanya
aspirasi</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 18.0pt; mso-list: l15 level1 lfo12; tab-stops: list 0cm; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span>Mengupayakan
jalan nafas tetap paten</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 18.0pt; mso-list: l15 level1 lfo12; tab-stops: list 0cm; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span>Memberikan
oksigen sesuai dengan indikasi</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 12.6pt; mso-list: l15 level1 lfo12; tab-stops: list -9.9pt; text-align: justify; text-indent: -12.6pt;">
<b><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span>Lakukan
penghisapan lendir dengan cara yang benar</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 18.0pt; mso-list: l15 level1 lfo12; tab-stops: list 0cm; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span>Siapkan
klien untuk pemasangan intubasi dan ambu bag.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 0cm; mso-list: l15 level1 lfo12; tab-stops: list 0cm; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span>Selalu ingatkan untuk menjaga kebersihan mulut </b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; text-align: justify; text-indent: 0cm;">
<b><span style="mso-spacerun: yes;"> </span>Untuk mencegah
aspirasi</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; text-align: justify; text-indent: 0cm;">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.9pt;" valign="top" width="37">
<div class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>3</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>Dx. 3 dan 4</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.5pt;" valign="top" width="174">
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>Mampu menampilkan konsep diri yang
positif</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.6pt;" valign="top" width="357">
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 18.0pt; mso-list: l5 level1 lfo13; tab-stops: list 8.85pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">1.</span>Anjurkan
klien untuk mengekspresikan perasaan</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l5 level1 lfo13; tab-stops: list -.15pt; text-align: justify; text-indent: -9.0pt;">
<b><span style="mso-list: Ignore;">2.</span>Ajarkan
klien dan keluarga untuk mengidentifikasi beberapa reaksi orang terhadap
pasien</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.1pt; mso-list: l5 level1 lfo13; tab-stops: list 3.6pt; text-align: justify; text-indent: -8.25pt;">
<b><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan dan ingatkan untuk mengidentifikasikan<span style="mso-spacerun: yes;">
</span>keberhasilan yang telah diperoleh</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -.15pt; mso-list: l5 level1 lfo13; tab-stops: list -.15pt; text-align: justify; text-indent: 0cm;">
<b><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Jangan terlalu melakukan proteksi terhadap klien</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l5 level1 lfo13; tab-stops: list -4.65pt; text-align: justify; text-indent: -9.0pt;">
<b><span style="mso-list: Ignore;">5.</span>Bantulah
klien untuk meluruskan kesan orang lain terhadap klien dan kesan klien
terhadap orang lain</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l5 level1 lfo13; tab-stops: list -4.65pt; text-align: justify; text-indent: -9.0pt;">
<b><span style="mso-list: Ignore;">6.</span>Selalu
bersikap tenang baik itu pasien, pemberi pelayanan atau keluarga saat terjadi
serangan kejang</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l5 level1 lfo13; tab-stops: list -4.65pt; text-align: justify; text-indent: -9.0pt;">
<b><span style="mso-list: Ignore;">7.</span>Anjurkan
untuk berkonsultasi dengan spesialis tertentu seperti psikolog</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l5 level1 lfo13; tab-stops: list -4.65pt; text-align: justify; text-indent: -9.0pt;">
<b><span style="mso-list: Ignore;">8.</span>Diskusikan
pentingnya untuk berusaha menerima keterbatasan yang ada.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l5 level1 lfo13; tab-stops: list -4.65pt; text-align: justify; text-indent: -9.0pt;">
<b><span style="mso-list: Ignore;">9.</span>Mampu
menyesuaikan pola hidup sesuai dengan keadaan klien</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: -.15pt; text-align: justify; text-indent: 0cm;">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.9pt;" valign="top" width="37">
<div class="MsoBodyTextIndent" style="margin-right: -5.5pt; tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>4</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>Dx. 5</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.5pt;" valign="top" width="174">
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<b>Mampu menjelaskan mengenai proses
peny., prognosa, kemungkinan komplikasi dan keterbatasan diri yang dimiliki
dan melaksanakan program pengobatan serta follow up secara tepat dan teratur</b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.6pt;" valign="top" width="357">
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.1pt; mso-list: l2 level1 lfo14; tab-stops: list 8.85pt; text-align: justify; text-indent: -8.1pt;">
<b><span style="mso-list: Ignore;">1.</span>Menjelaskan
kembali proses penyakit serta prognosanya.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l2 level1 lfo14; tab-stops: list 8.85pt; text-align: justify; text-indent: -8.85pt;">
<b><span style="mso-list: Ignore;">2.</span>Menjelaskan
kembali tentang pentingnya obat serta mengobservasi efek dari obat tersebut.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l2 level1 lfo14; tab-stops: list 8.85pt; text-align: justify; text-indent: -8.85pt;">
<b><span style="mso-list: Ignore;">3.</span>Buatkan
petunjuk yang jelas dalam pemberian obat, dan selalu diingatkan bahwa dosis
terapeutik saat ini dapat berubah suatu saat.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l2 level1 lfo14; tab-stops: list 8.85pt; text-align: justify; text-indent: -8.85pt;">
<b><span style="mso-list: Ignore;">4.</span>Diskusikan
efek samping dari obat.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l2 level1 lfo14; tab-stops: list 8.85pt; text-align: justify; text-indent: -8.85pt;">
<b><span style="mso-list: Ignore;">5.</span>Anjurkan
agar klien membawa tanda khusus.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 8.85pt; mso-list: l2 level1 lfo14; tab-stops: list 8.85pt; text-align: justify; text-indent: -8.85pt;">
<b><span style="mso-list: Ignore;">6.</span>Jelaskan
pentingnya follow up.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; text-align: justify; text-indent: 0cm;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 27.9pt;" valign="top" width="37">
<div class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 63.0pt;" valign="top" width="84">
<div class="MsoBodyTextIndent" style="tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.5pt;" valign="top" width="174">
<div class="MsoBodyTextIndent" style="line-height: normal; tab-stops: 36.0pt 2.0cm; text-align: justify; text-indent: 0cm;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 267.6pt;" valign="top" width="357">
<div class="MsoBodyTextIndent" style="line-height: normal; text-align: justify; text-indent: 0cm;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoBodyTextIndent" style="tab-stops: 2.0cm 92.15pt; text-align: justify; text-indent: 0cm;">
<br /></div>
<div class="MsoBodyTextIndent" style="margin-left: 18.05pt; mso-list: l2 level1 lfo14; tab-stops: list 36.0pt left 2.0cm 92.15pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Evaluasi</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 31.5pt; tab-stops: 0cm; text-align: justify; text-indent: 40.5pt;">
<b>Evaluasi merupakan bagian akhir dari proses
keperawatan. Evaluasi dilakukan untuk mengetahui tingkat keberhasilan tindakan
yang telah dilakukan. Disamping itu evaluasi dapat dijadikan sebagai bahan
pengkajian untuk proses berikutnya.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 31.5pt; tab-stops: 0cm; text-align: justify; text-indent: 40.5pt;">
<b>Pada kasus epilepsi evaluasi dilakukan atas
tindakan yang dilakukan sesuai dengan diagnosa dan tujuan yang sudah
ditetapkan.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 54.0pt; mso-list: l13 level1 lfo15; tab-stops: 0cm list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Frekuensi dan faktor pencetus serangan dapat
diidentifikasi, lingkungan aman, klien tahu berperilaku untuk mencegah trauma
jika muncul serangan, keluarga tidak meninggalkan klien sendiri terutama saat
faktor pencetus paparannya meningkat.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 54.0pt; mso-list: l13 level1 lfo15; tab-stops: 0cm list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien dapat mengambil posisi yang stabil, tidak menelan
sesuatu, jika fase aura mulai muncul, kebutuhan O2 klien dapat terpenuhi
terutama pada saat serangan.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 54.0pt; mso-list: l13 level1 lfo15; tab-stops: 0cm list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mampu menampakkan kesan diri yang positif,
keluarga aktif memberikan dukungan dukungan kepada klien.</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 54.0pt; mso-list: l13 level1 lfo15; tab-stops: 0cm list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b>Klien
mampu menjelaskan tentang penyakit, penanganan, prognose, serta waktu
pengobatan. Klien mengerti dan mau melakukan follow up secara teratur. Klien
dapat menyesuaikan pola hidupnya sesuai dengan keadaannya</b></div>
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<b style="mso-bidi-font-weight: normal;">DAFTAR PUSTAKA</b></div>
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<br /></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.3pt;">
<b>Dongoes M. E. et all,
1989, <u>Nursing Care Plans</u>, Guidelines for Planning Patient Care, Second
Ed, F. A. Davis, Philadelpia.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.3pt;">
<br /></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<b>Harsono (ED), 1996, <u>Kapita
Selekta Neurologi</u> , Second Ed, Gajah Mada University Press, Yogyakarta.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<br /></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<b>Hudac. M. C. R and Gallo
B. M, 1997, <u>Keperawatan Kritis Pendekatan Holistik</u> (Terjemahan), Edisi
VI, EGC, Jakarta Indonesia.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<br /></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<b>Kariasa Made, 1997, <u>Asuhan
Keperawatan Klien Epilepsi</u>, FIK-UI, Jakarta<u>.</u></b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<br /></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<b>Luckman and Sorensen S,
1993, <u>Medikal Surgical Nursing<span style="mso-spacerun: yes;">
</span>Psychology Approach</u>, Fourt Ed, Philadelpia London.</b></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<br /></div>
<div class="MsoBodyTextIndent" style="line-height: normal; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify; text-indent: -40.5pt;">
<b>Price S. A and Wilson L.
M, 1982, <u>Pathofisiology</u>, Clinical Concepts of Desease Process, Second
Ed, St Louis, New York.</b></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-43879636147045803292011-11-10T07:27:00.001-08:002011-11-10T07:28:53.463-08:00HIPERTIROIDISME<!--[if gte mso 9]><xml>
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ASUHAN KEPERAWATAN PADA PASIEN </div>
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DENGAN HIPERTIROIDISME</div>
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<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Definisi</b></div>
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Hipertiroid adalah suatu ketidakseimbangan
metabolik yang merupakan akibat dari produksi hormon tiroid yang berlebihan.
(Dongoes E, Marilynn , 2000 hal 708)</div>
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<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Etiologi</b></div>
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Penyebab-penyebabnya antara lain:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l9 level2 lfo4; tab-stops: list 18.0pt; text-align: justify; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Herediter</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Toksik Adenoma</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tumor kelenjar hipofise</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tiroiditis sub akut</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kanker tiroid</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Terapi<span style="mso-spacerun: yes;">
</span>hormon tiroid berlebihan</div>
<div class="MsoBodyTextIndent3" style="margin-left: 0cm; text-indent: 0cm;">
<span style="mso-spacerun: yes;"> </span>(Price A, Sylvia, 1995, hal 1074 dan
Dongoes E, Marilynn , 2000 hal 708)</div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Faktor resiko </b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l34 level2 lfo5; tab-stops: list 18.0pt; text-align: justify; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: bold;">Terjadi lebih banyak pada wanita dari pada
laki-laki</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: bold;">Pada usia lebih dari 50 tahun</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: bold;">Post trauma emosional</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l34 level2 lfo5; tab-stops: list 18.0pt; text-align: justify; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: bold;">Peningkatan stress</span></div>
<div class="MsoBodyTextIndent" style="text-indent: 0cm;">
(Long C, Barbara 1996 hal
109)</div>
<div class="MsoBodyTextIndent" style="text-indent: 0cm;">
<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Manifestasi klinis</b></div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Apatis </div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mudah lelah</div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kelemahan otot</div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mual</div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Muntah</div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Gemetaran</div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kulit lembab</div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berat badan turun</div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Takikardi</div>
<div class="MsoBodyTextIndent" style="margin-left: 18.0pt; mso-list: l21 level2 lfo6; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">N<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mata melotot, kedipan mata berkurang</div>
<div class="MsoBodyTextIndent" style="text-indent: 0cm;">
(Smeltzer C. Suzanne, 2002,
hal 1319 dan<span style="mso-spacerun: yes;"> </span>Price A, Sylvia, 1995, hal
1076)</div>
<div class="MsoBodyTextIndent">
<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: .7pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l17 level1 lfo1; tab-stops: list 14.7pt 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Pemeriksaan Penunjang</b></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tes ambilan RAI: meningkat pada penyakit graves
dan toksik goiter noduler, menurun pada tiriditis</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>T3 dan T4 serum : meningkat</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>T3 dan T4 bebas serum : meningkat</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>TSH: tertekan dan tidak berespon pada TRH (
tiroid releasing hormon)</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tiroglobulin : meningkat</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Stimulasi tiroid 131 : dikatakan hipertiroid
jika TRH daritidak ada sampai meningkat setelah pemberian TRH</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l28 level2 lfo7; tab-stops: list 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Ambilan tiroid 131 : meningkat</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Ikatan protein sodium : meningkat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l28 level2 lfo7; tab-stops: list 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Gula darah : meningkat ( kerusakan adrenal)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l28 level2 lfo7; tab-stops: list 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kortisol plasma : turun ( menurunnya pengeluaran
oleh adrenal)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l28 level2 lfo7; tab-stops: list 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pemerksaan fungsi hepar : abnormal</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l28 level2 lfo7; tab-stops: list 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Elektrolit : hponatremi akibat respon adrenal
atau efe delusi terapi cairan, hipokalemia akibat dari deuresis dan kehilangan
dari GI</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kateklamin serum : menurun</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l28 level2 lfo7; tab-stops: list 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>kreatinin urin : meningkat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l28 level2 lfo7; tab-stops: list 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>EKG : fibrilasi atrium, waktu sistolik memendek
kardiomegali</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
(DoengesE, Marilynn,2000 hal 711)</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l17 level1 lfo1; tab-stops: list 14.7pt 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Penatalaksanaan</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l31 level1 lfo9; tab-stops: 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengobatan jangka panjang dengan obat-obat antitiroid
seperti propiltiourasil atau metimazol yang diberikanpaling sedikit selama satu
tahun. Obat – obat ini menghambat<span style="mso-spacerun: yes;">
</span>sintesis dan pelepasan tiroksin.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l31 level1 lfo9; tab-stops: 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pembedahan tiroideksomi sub total sesudah terapi
propiltiourasil prabedah</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l31 level1 lfo9; tab-stops: 37.4pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengobatan dengan yodium radioaktif</div>
<div class="MsoBodyTextIndent" style="tab-stops: 37.4pt; text-indent: 0cm;">
(Price A,
Sylvia, 1995, hal 1076)</div>
<div class="MsoBodyTextIndent" style="text-indent: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l17 level1 lfo1; tab-stops: list 14.7pt 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Komplikasi</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l7 level2 lfo8; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Penyakit jantung </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l7 level2 lfo8; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Gagal ginjal kronis</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l7 level2 lfo8; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Fraktur</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l7 level2 lfo8; tab-stops: list 37.4pt; text-indent: .7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Krisis tiroid</div>
<div class="MsoBodyTextIndent" style="text-indent: 0cm;">
(Smeltzer C. Suzanne, 2002,
hal 1319)</div>
<div class="MsoBodyTextIndent" style="text-indent: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l17 level1 lfo1; tab-stops: list 14.7pt 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Pengkajian</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
1. Aktivitas dan istirahat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l4 level2 lfo10; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data Subyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l47 level1 lfo11; tab-stops: list 18.0pt left 56.1pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü</span></span>Insomnia,
sensitivitas meningkat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l47 level1 lfo11; tab-stops: list 18.0pt left 56.1pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü</span></span>Otot lemah,
gangguan koordinasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l47 level1 lfo11; tab-stops: list 18.0pt left 56.1pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü</span></span>Kelelahan
berat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l4 level2 lfo10; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data obyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l33 level1 lfo12; tab-stops: list 18.0pt left 56.1pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü</span></span>Atrofi otot</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
2. Sirkulasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l10 level2 lfo13; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data Subyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l42 level1 lfo14; tab-stops: list 18.0pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Palpitasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l42 level1 lfo14; tab-stops: list 18.0pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri dada</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l10 level2 lfo13; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data obyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l2 level1 lfo15; tab-stops: list 18.0pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Disritmia (fibrilasi atrium), irama<span style="mso-spacerun: yes;"> </span>galop, murmur</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l2 level1 lfo15; tab-stops: list 18.0pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Peningkatan tekanan darah, takikardi saat
istirahat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l2 level1 lfo15; tab-stops: list 18.0pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Sirkulasi kolaps</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
3. Integritas ego</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l39 level2 lfo16; tab-stops: 46.75pt list 65.45pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data Subyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l38 level1 lfo17; tab-stops: list 18.0pt left 46.75pt 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mengalami stress yang berat baik emosional
maupun fisik</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l39 level2 lfo16; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data obyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l18 level1 lfo18; tab-stops: list 18.0pt left 46.75pt 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Emosi labil (euforia sampai delirium), depresi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
4. Eliminasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l3 level2 lfo19; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data Subyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l29 level1 lfo20; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Urin dalam jumlah banyak</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l29 level1 lfo20; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Perubahan dalam feses : diare</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
5. Makan/ minum</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l12 level2 lfo21; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data Subyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l56 level1 lfo22; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kehilangan BB yang mendadak</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l56 level1 lfo22; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nafsu makan meningkat, makan banyak, makan
sering, kehausan. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l56 level1 lfo22; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mual muntah</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l12 level2 lfo21; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data obyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l14 level1 lfo23; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pembesaran tiroid, goiter</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l14 level1 lfo23; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Edema non pitting terutama daerah pretibial</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
6. Sensori neural </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l11 level2 lfo24; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data obyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l46 level1 lfo25; tab-stops: 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bicara cepat dan parau</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l46 level1 lfo25; tab-stops: 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Ganggguan status mental dan perilaku seperti
bingung, disorentai, gelisah, peka rangsang, delirium, sikosis, stupor,koma</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l46 level1 lfo25; tab-stops: 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tremor halus pada tanan, tanpa tujuan, beberapa
bagian tersentak-sentak</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l46 level1 lfo25; tab-stops: 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hiperaktif reflekstenon dalam (RTD)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
7. Nyeri / kenyamanan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l0 level2 lfo26; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data Subyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l16 level1 lfo27; tab-stops: list 18.0pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri orbital, fotofobia</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
8. Respirasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l25 level2 lfo28; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tanda:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l23 level1 lfo29; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Frekuensi pernapasan meningkat, takipnea</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l40 level1 lfo30; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dispnea</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
9.Keamanan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l55 level2 lfo31; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data subyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 153.0pt; mso-list: l55 level3 lfo31; tab-stops: 65.45pt list 153.0pt; text-align: justify; text-indent: -106.25pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tidak toleransi terhadap panas, keringat
berlebihan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 153.0pt; mso-list: l55 level3 lfo31; tab-stops: 65.45pt list 153.0pt; text-align: justify; text-indent: -106.25pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Alergi terhadapiodium 9 mungkin digunakan pada
pemeriksaan)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; mso-list: l55 level2 lfo31; tab-stops: 46.75pt list 108.0pt; text-align: justify; text-indent: -79.95pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data obyektif:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l8 level2 lfo2; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span></span></span>Suhu meningkat diatas 37,4 C, diaforesis</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l8 level2 lfo2; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kulit halus, hangat dan kemerahan, rambut tipis,
mengkilat dan lurus</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l8 level2 lfo2; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span></span></span>Eksoptalmus: retraksi, iritas pada kinjungtiva
dan berair. Pruritus, lesi eritema ( sering terjadi pada pretibial yang menjadi
sangat parah</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
10. Seksualitas</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l43 level1 lfo32; tab-stops: list 18.0pt left 46.75pt; text-align: justify; text-indent: 19.4pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span>Data
obyektif;</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l53 level1 lfo33; tab-stops: list 18.0pt left 65.45pt; text-align: justify; text-indent: 28.75pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Penurunan libido, hipomenorea, amenorea dan
impoten</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 16.8pt; text-align: justify;">
11. Penyuluhan/ pembelajaran</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l43 level1 lfo32; tab-stops: list 18.0pt left 46.75pt; text-align: justify; text-indent: 19.4pt;">
<span style="mso-list: Ignore;">b.</span>Subjektif Data<span style="mso-tab-count: 1;"> </span>:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l6 level1 lfo34; tab-stops: 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Riwayat keluarga yang mengalami masalah tiroid</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l6 level1 lfo34; tab-stops: 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="mso-spacerun: yes;"> </span>Riwayat
hipotiroidis, terapi hormontiroid atau pengobatan antitiroid, dihentikan
terhadap pengobatan antitiroid, dilakukan pembedahan tiroidektomi sebagian</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l6 level1 lfo34; tab-stops: 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>riwayat pemberian insulin yang menyebabkan
hipoglikemia, gangguan jantung trauma, pemeriksaan rontgen dengan zat kontras</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
(DoengesE, Marilynn,2000 hal 708 -709)</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Diagnosa Keperawatan</b></div>
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<b>1.<span style="mso-tab-count: 1;"> </span>Penurunan curah jantung b.d hipertiroid tidak
terkontrol,hipermetabolisme, peningkatan beban kerja jantung</b></div>
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Tujuan<span style="mso-spacerun: yes;"> </span>Pasien
/ criteria evaluasi ;</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>mempertahankan curah jantung yang adekuat sesuai
dengan kebutuhan tubuh yang ditandai dengan TTV stabil, denyut nadi perifer
normal, pengisian kapiler normal, status mental baik,tidak ada disritmia</div>
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<b>Intervensi :</b></div>
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a.<span style="mso-tab-count: 1;"> </span>Independen
</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pantau TTV. Perhatikan besarnya tekanan nadi</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Periksa /teliti kemungkinan nyeri dada yang
dikeluhkan pasien</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kaji nadi/denyut jantung saat pasien tidur</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Auskultasi suara jantung, perhatikan adanya
bunyi jantung tambahan, adanyairamagallop dan murmur sistolik</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pantau EKG, catat atau perhatikan kecepatan atu
irama jantung dan adanya disritmia</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Observasi tanda dan gejala kehausan yang hebat,
mukosa membran kering, nadilemah, pengisian kaapiler lambat, penurunan produksi
urin dan hipotensi</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Catat adnya riwayat asma/bronkokontriksi,
kehamilan,sinus bradikardi/blok jantung yang berlanjut menjadi gagal jantung</div>
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b.<span style="mso-tab-count: 1;"> </span>Kolaborasi</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan cairan melalui IV sesuai indikasi</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan obat sesuai dengan indkasi:</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Penyekat beta seperti: propanolol (inderal0,
atenolol (tenormin), nadolol (corgard)</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hormon tirid antagonis seperti propiltirourasil
(PTU), metimazol (tapazole)</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Natriun iodida (lugol) atau saturasi kalium iodida</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>RAI (<sup>131</sup> InaL atau <sup>125 </sup>InaL)</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kortikosteroid, Digoksin, Furosemid, Asetaminofen</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pantau hasil pemeriksaan lab : kalium serum,
kalsium serum,kultur sputum</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Lakukan pemantauan EKG secara teratur</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan oksigen sesuai indikasi</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Siapkan untuk pembedahan</div>
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<b>2. Kelelahan b.d hipermetabolik
dengan peningkatan kebutuhan energi,peka rangsang dari saraf sehubungan dengan
gangguan kimia tubuh</b></div>
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Dibuktikan oleh :</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mengungkapkan sangat kurang kekurangan<span style="mso-spacerun: yes;"> </span>energi untuk mempertahankan utinitas umum,
penurunan penampilan</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Labilias/pekarangsang emsional, gugup, tegang</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Perilaku gelisah</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kerusakan kemampuan untuk konsentrasi</div>
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<span style="mso-tab-count: 1;"> </span>Tujuan
Pasien / criteria evaluasi ;</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Menungkapkan secara verbal tentang peningkatan
energi</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Menunjukkkan perbaikan kemampuan untuk
berpartisipasi dalam melakukan aktivits</div>
<h4>
Intervensi </h4>
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a.<span style="mso-tab-count: 1;"> </span>Independen</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pantau TTV sebelum dan sesudah aktivitas</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Catat perkembangan takipnea, dispnea, pucat dan
sianosis</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Ciptakan lingkungan yang tenang, ruangan yang
dingin, turunkan stimulasi sensori, warna-warna yang sejuk dan situasi yang tenang</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Sarankan pasien untuk mengurangi aktivitas dan
meningkatkan istirahat ditempat tidur jika memungkinkan</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan tindakan yang membuat pasien nyaman
seperti masage/sentuhan, bedak yang sejuk</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Memberikan aktivits pengganti yang nyaman
seperti membaca, mendengarkan radio</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hindari membicarakan topik yang menjengkelkan
atau yang mengancam pasien. Diskusikan cara untuk berspon terhadap perasaan
tersebut</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Diskusikan dengan orang dekat tentang<span style="mso-spacerun: yes;"> </span>keadaan kelelahan dan emosi yang tidak stabil</div>
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b.<span style="mso-tab-count: 1;"> </span>Kolaborasi</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan obat<span style="mso-spacerun: yes;">
</span>sesuai indikasi sseperti sedatif : fenobarbital (luminal)</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -18.65pt;">
3. <span style="mso-tab-count: 1;"> </span><b>Perubahan
nutrisi kurang dari kebutuhan b.d peningkatan metaboisme ( peningkatan nafsu
makan/pemasukan dengan penururunan BB)</b></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 37.4pt; text-align: justify;">
<span style="mso-tab-count: 1;"> </span>Tujuan pasien / criteria evaluasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l52 level1 lfo42; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Menunjukkkan BB yang stabil disertai dengan
nilai laboratorium yang normal dan terbebas dari tanda-tanda malnutrisi</div>
<h4>
Intervensi</h4>
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a.<span style="mso-tab-count: 1;"> </span>Independen</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l32 level1 lfo43; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Auskultasi bising usus</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l32 level1 lfo43; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Catat dan laporkan adanyaanoreksia, kelemahan
umum/nyei,nyeri abdomen, munculnya mual-muntah</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pantau masukan makanan setiap hari. Dan timbang
bb setipa hari serta laporkan adanya penurunan BB</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l32 level1 lfo43; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dorong pasien untuk makandan meningkatkan jumlah
makan dan juga makanan kecil dengan menggunakan makanan tinggi kalori yang
mudah dicerna</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l32 level1 lfo43; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hindari pemberian makananyang dapat meningkatkan
peristaltik usus (eh, kopi dan makanan berserat lainnya ) dan cairan yang
menyebabkan diare</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l32 level1 lfo43; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bicara<span style="mso-spacerun: yes;">
</span>dengan nada normal</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; tab-stops: 56.1pt; text-align: justify; text-indent: -34.6pt;">
b.<span style="mso-tab-count: 1;"> </span>Kolaborasi
:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l26 level1 lfo44; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Konsul<span style="mso-spacerun: yes;">
</span>dengan ahli gizi untuk memberikan diet tinggi kalori, protein,
karbohidart dan vitamin</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l26 level1 lfo44; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan obat dengan indikasi: glukosa,vit B
kompleks,Insulin (dengan dosis kecil)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; tab-stops: 37.4pt; text-align: justify; text-indent: -20.6pt;">
<b>4. Kerusaka integritas jaringan
mata b.d perubahan mekanisme perlindungan dari mata</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; tab-stops: 37.4pt; text-align: justify; text-indent: -43.65pt;">
<span style="mso-tab-count: 1;"> </span>Tujuan
/ criteria hasil :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level1 lfo45; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dapat mempertahakan kelembaban membran mukosa
mata, terbebas dari ulkus</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level1 lfo45; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mampu mengidentifikasi tindakan untuk
memberkanperlindungan pada mata dan pencegahan komplikasi</div>
<h5 style="tab-stops: 37.4pt;">
<span style="mso-tab-count: 1;"> </span>Intervensi</h5>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; tab-stops: 56.1pt; text-align: justify; text-indent: -34.6pt;">
a.<span style="mso-tab-count: 1;"> </span>Independen</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l5 level1 lfo46; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Observasi edema peiorbital, gangguan penutupan
kelopakmata. Lapang pandang penglihatan yang sempit, air ata yang berlebihan.
Catat adanya fotofobia, rasa adanya benda diluar mata dan nyeri pada mata</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l5 level1 lfo46; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Evaluasi ketajaman mata, laporkan adanya
pandangan yang kabur atau pandangan ganda( diplopia)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l5 level1 lfo46; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Anjurkan pasien menggunakan kaca mata gelap
ketika bangaundan tutup dengan peneutup mata selamatidur sesuai kebutuhan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l5 level1 lfo46; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bagian kepala tempat tidur ditinggikan dan
batasi pemasukan garam jika ada indikasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l5 level1 lfo46; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan kesempatan pasian untuk mendiskusokan
perasaaan tentang perubahanganbaran atau betuk tubuh untuk meningkatkan
gambanran tubuh</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l5 level1 lfo46; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Instruksikan agar pasien melatih otot mata
ekstraokular jika memungkinkan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; tab-stops: 56.1pt; text-align: justify;">
b.<span style="mso-tab-count: 1;"> </span>Kolaborasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l19 level1 lfo47; tab-stops: list 36.0pt left 74.8pt; text-align: justify; text-indent: 20.1pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>obat tetes mata metilselulosa</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l19 level1 lfo47; tab-stops: list 36.0pt left 74.8pt; text-align: justify; text-indent: 20.1pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>ACTH, prednison</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l19 level1 lfo47; tab-stops: list 36.0pt left 74.8pt; text-align: justify; text-indent: 20.1pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Obat antitiroid</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l19 level1 lfo47; tab-stops: list 36.0pt left 74.8pt; text-align: justify; text-indent: 20.1pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Diuretik</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l19 level1 lfo47; tab-stops: list 36.0pt left 74.8pt; text-align: justify; text-indent: 20.1pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Siapkan pembedahan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; text-align: justify; text-indent: -18.7pt;">
<b>5. <span style="mso-tab-count: 1;"> </span>Cemas
b.d faktor fisiologis, status hipermetabolik (stimulasi SSP), efek
pseudokatekolamin dari hormon tiroid</b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;">
<span style="mso-tab-count: 1;"> </span>Ditandai dengan : </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l27 level1 lfo48; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Peningkatan perasaan kuatir, gemetar, hilang
konrol, panik, perubahan kognitif, distosi rangsanglingkungan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l27 level1 lfo48; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Gerakan ekstra, gelisah, tremor</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;">
<span style="mso-tab-count: 1;"> </span>Kriteria hasil: </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l37 level1 lfo49; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tampak rileks</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l37 level1 lfo49; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Melapokan ansietasberkurang sampai tingkat dapt
dilatasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l37 level1 lfo49; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mampu mengidentifikasi cara hidup yang sehat
untuk membagikan perasaannya</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 37.4pt; text-align: justify;">
<b><span style="mso-tab-count: 1;"> </span>Intervensi:</b></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 56.1pt; text-align: justify; text-indent: 37.4pt;">
<b>a.<span style="mso-tab-count: 1;"> </span>Mandiri</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Observasi tingkah laku pasien yang menunjukkan
tingkat ansietas</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pantau respon fisik, papitsi, gerakan yang
berulang-ulang, hiperventilasidan insomnia</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tinggal bersama pasien, mempertahankan sikap
yang teang. Mngakui atau menjawab kekuatiran dan mengijinkan perilaku pasien
yang umum</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Jelaskan prosedur, lingkungan sekelilmn atau
suara yang mungkindidengar oleh pasien</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bicara yang singkat dengan kata yang sederhana</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kurangi stimulasidari luar. Tempatkan pada
ruangan yang tenang, berikan kelembutan, kurangi lampu yang terang, kurangi
jumlah orang yang berkunjuang</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Diskusikan dengan pasien aau orang yang terdekat
penyebab emosional yang labil/reaksi psikotik</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tekankan harapan bahwa pengendalian emosi itu
harus tetap diberikan sesuai denagan perkembangan terapi obat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify; text-indent: -16.6pt;">
b.<span style="mso-tab-count: 1;"> </span>Kolaborasi;</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l13 level1 lfo50; tab-stops: 18.7pt list 36.0pt; text-align: justify; text-indent: 20.1pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan obat antiansietas</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l13 level1 lfo50; tab-stops: 18.7pt list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Rujukpada sistem penyokong sesuai dengan
kebutuhan seperti konseling, ahli agama dan pelayanan sosial</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; tab-stops: 18.7pt; text-align: justify; text-indent: 20.1pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; text-align: justify; text-indent: -18.7pt;">
<b>6. Perubahan prossespikir b.d perubahan
fisiologis, peningkatan stimulasi SSP/mempercepat aktivitas mental</b></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 37.4pt; text-align: justify; text-indent: 18.0pt;">
<span style="mso-tab-count: 1;"> </span>Kriteria
hasil: </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l51 level1 lfo51; tab-stops: list 36.0pt left 56.1pt; text-align: justify; text-indent: 1.4pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mempertahankan orientasi realita umumya</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l51 level1 lfo51; tab-stops: list 36.0pt left 56.1pt; text-align: justify; text-indent: 1.4pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mengenali perubahan dalam berpikir/perilaku dan
faktor penyebab</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;">
<span style="mso-tab-count: 1;"> </span>Intervensi:</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 37.4pt 56.1pt; text-align: justify; text-indent: 18.0pt;">
<span style="mso-tab-count: 1;"> </span>a.<span style="mso-tab-count: 1;"> </span>Mandiri</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l44 level1 lfo52; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kaji proses pikir pasienseperti memori, rentang
perhatian, orientasi terhadap tempat, waktu atauorang</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l44 level1 lfo52; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Catat adanya perubahan tingkahlaku</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l44 level1 lfo52; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hadirkan pada realita secara terusmenerus
dansecara gamblang tanpa melawan pikiran yang tidak logis</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l44 level1 lfo52; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Memberikan tindakan yang aman seperti bantalan
pada enghalang tempat tidur, pengikatan yang lembutsupervisi yang ketat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l44 level1 lfo52; tab-stops: 74.8pt; text-align: justify; text-indent: -18.7pt;">
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untuk mengunjungi paisen. Memberikan dukungan dengan kebutuhan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 37.4pt 56.1pt; text-align: justify;">
<span style="mso-tab-count: 1;"> </span>b.<span style="mso-tab-count: 1;"> </span>Kolaborasi</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
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<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; tab-stops: 37.4pt; text-align: justify; text-indent: -18.7pt;">
<b>7.<span style="mso-tab-count: 1;"> </span>Kurang pengetahuan mengenai kondisi, prognosis dan kebutuhan
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<span style="mso-tab-count: 2;"> </span>Ditandai dengan:</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pertanyaan, meminta informasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<span style="mso-tab-count: 1;"> </span>Kriteria evaluasi:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo55; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pasien mengerti tentang proses penyakit dan
pengobatannya</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo55; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
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</span></span></span>Mengidentifikasi hubungan antara tanda dan
gejalapada prosses penyakit dan hubungan gejala dengan faktor penyebabnya</div>
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<b><span style="mso-tab-count: 1;"> </span>Intervensi;</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; tab-stops: 56.1pt; text-align: justify; text-indent: -18.7pt;">
a.<span style="mso-tab-count: 1;"> </span>Mandiri</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l20 level1 lfo56; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
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</span></span></span>Berikan informasi yang tepat dengan keadaan
individu</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l20 level1 lfo56; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
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</span></span></span>Berikan informasi tanda dan gejala dari
hipertiroid </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l20 level1 lfo56; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
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</span></span></span>Diskusikan mengenai terapi obat termasuk
ketaatan terhadap pengobatan dan tujuan terapi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l20 level1 lfo56; tab-stops: list 74.8pt; text-align: justify; text-indent: -18.7pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tinjau kebutuhan diiit makanan dan tinjau ulang
mengenai nutrisi . Mdnghindari kopi, makanan pengawet dan makanan pewarna</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 37.4pt 56.1pt; text-align: justify;">
<span style="mso-tab-count: 1;"> </span>b.<span style="mso-tab-count: 1;"> </span>Kolaborasi:</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pemberian anti emetikdengan jadwal reguler</div>
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<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l54 level1 lfo57; tab-stops: list 54.0pt left 74.8pt; text-align: justify; text-indent: 2.1pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Rujuk ahli diit</div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pasang /pertahankan slang NGT untuk pemberian
makanan enteral</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
(Doenges E, Marilynn, 2000 ha</div>
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<br /></div>
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<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 37.4pt;">
<b style="mso-bidi-font-weight: normal;">DAFTAR PUSTAKA</b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 0cm; mso-list: l50 level1 lfo3; text-align: justify; text-indent: 0cm;">
<span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span></span>Long C, Barbara, <b>Perawatan Medikal Bedah,</b> Jilid
3, Bandung,
Yayasan Ikatan Alumni Pendidikan Keperawatan Pajajaran, 1996</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 0cm; mso-list: l50 level1 lfo3; text-align: justify; text-indent: 0cm;">
<span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span></span>Price A, Sylvia dan Wilson M, Lorraine, <b>Patofisiologi: Konsep Klinis
Proses-Proses Penyakit</b>, Edisi 4, Buku II, Jakarta, EGC,1995</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 0cm; mso-list: l50 level1 lfo3; text-align: justify; text-indent: 0cm;">
<span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span></span>Hudak & Gallo, <b>Keperawatan Kritis: Pendekaatan
Holistik</b>, Edisi 6, Volume II, Jakarta,
EGC,1996</div>
<div class="MsoBodyTextIndent" style="margin-left: 35.95pt; text-indent: -17.25pt;">
4.<span style="mso-tab-count: 1;"> </span>Smeltzer C. Suzanne, Brunner &
Suddarth,<span style="mso-spacerun: yes;"> </span><b>Buku Ajar Keperawatan
Medikal Bedah, </b>Jilid 3, Jakarta, EGC ,2002</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 35.95pt; text-align: justify; text-indent: -21.75pt;">
<span style="mso-spacerun: yes;"> </span>5. <span style="mso-tab-count: 1;"> </span>Marilynn E, Doengoes, 2000, <b>Rencana Asuhan
Keperawatan,</b><i> </i>Edisi 3, Jakarta,<span style="mso-spacerun: yes;"> </span>EGC, 2000</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.95pt; text-align: justify; text-indent: -17.25pt;">
<span style="mso-tab-count: 1;"> </span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-67127041883363610792011-11-10T07:26:00.001-08:002011-11-10T07:29:37.202-08:00ASKEP HEPATITIS<!--[if !mso]>
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<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; font-size: 16.0pt; line-height: 150%;">HEPATITIS</span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l11 level1 lfo12; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">DEFINISI
</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Hepatitis</span></i></b><span style="font-family: "Verdana","sans-serif";"> adalah suatu proses peradangan
difus pada jaringan yang dapat disebabkan oleh infeksi virus dan oleh reaksi
toksik terhadap obat-obatan serta bahan-bahan kimia. (Sujono Hadi, 1999).</span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Hepatitis virus</span></i></b><span style="font-family: "Verdana","sans-serif";"> merupakan infeksi sistemik oleh
virus disertai nekrosis dan klinis, biokimia serta seluler yang khas (smeltzer,
2001)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<br /></div>
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</span></b></div>
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<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Virus </span></b></li>
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<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 66.85pt;" valign="top" width="89">
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<br /></div>
</td>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Type
A</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Type
B</span></b></div>
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<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.95pt;" valign="top" width="104">
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Type
C</span></b></div>
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<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 92.15pt;" valign="top" width="123">
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Type
D</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Type
E</span></b></div>
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<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Verdana","sans-serif";">Metode trasnmisi</span></div>
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<span style="font-family: "Verdana","sans-serif";">Fekal-oral melalui orang lain</span></div>
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<span style="font-family: "Verdana","sans-serif";">Parenteral seksual, perinatal</span></div>
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<span style="font-family: "Verdana","sans-serif";">Parenteral jarang seksual, orang ke
orang, perinatal</span></div>
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<span style="font-family: "Verdana","sans-serif";">Parenteral perinatal, memerlukan
koinfeksi dengan type B</span></div>
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<br /></div>
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<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Verdana","sans-serif";">Fekal-oral</span></div>
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<span style="font-family: "Verdana","sans-serif";">Keparah-an</span></div>
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<span style="font-family: "Verdana","sans-serif";">Tak ikterik dan asimto- matik</span></div>
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<span style="font-family: "Verdana","sans-serif";">Parah</span></div>
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<span style="font-family: "Verdana","sans-serif";">Menyebar luas, dapat berkem-bang
sampai kronis</span></div>
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<span style="font-family: "Verdana","sans-serif";">Peningkatan insiden kronis dan
gagal hepar akut</span></div>
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<br /></div>
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<span style="font-family: "Verdana","sans-serif";">Sama dengan D</span></div>
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<span style="font-family: "Verdana","sans-serif";">Sumber virus</span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-bottom-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-right-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 60.3pt;" valign="top" width="80">
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<span style="font-family: "Verdana","sans-serif";">Darah, feces, saliva</span></div>
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<span style="font-family: "Verdana","sans-serif";">Darah, saliva, semen, sekresi
vagina</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-bottom-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-right-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.95pt;" valign="top" width="104">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Verdana","sans-serif";">Terutama melalui darah</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-bottom-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-right-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 92.15pt;" valign="top" width="123">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Verdana","sans-serif";">Melalui darah</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-bottom-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-right-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 2.0cm;" valign="top" width="76">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Verdana","sans-serif";">Darah, feces, saliva</span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Alkohol </span></b></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Menyebabkan alkohol
hepatitis dan selanjutnya menjadi alkohol sirosis.</span></div>
<ol start="3" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Obat-obatan </span></b></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Menyebabkan toksik untuk
hati, sehingga sering disebut hepatitis toksik dan hepatitis akut.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l11 level1 lfo12; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">TANDA
DAN GEJALA </span></b></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Masa tunas </span></i></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 155.95pt 163.05pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Virus
A<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>15-45 hari (rata-rata 25 hari)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 155.95pt 163.05pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Virus
B<span style="mso-tab-count: 1;"> </span>:<span style="mso-tab-count: 1;"> </span>40-180 hari (rata-rata 75 hari)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 155.95pt 163.05pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Virus
non A dan non B<span style="mso-tab-count: 1;"> </span>: 15-150 hari (rata-rata
50 hari)</span></div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Fase Pre Ikterik </span></i></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Keluhan umumnya tidak
khas. Keluhan yang disebabkan infeksi virus berlangsung sekitar 2-7 hari. Nafsu
makan menurun (pertama kali timbul), nausea, vomitus, perut kanan atas (ulu
hati) dirasakan sakit. Seluruh badan pegal-pegal terutama di pinggang, bahu dan
malaise, lekas capek terutama sore hari, suhu badan meningkat sekitar 39<sup>o</sup>C
berlangsung selama 2-5 hari, pusing, nyeri persendian. Keluhan gatal-gatal
mencolok pada hepatitis virus B.</span></div>
<ol start="3" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Fase Ikterik </span></i></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Urine berwarna seperti
teh pekat, tinja berwarna pucat, penurunan suhu badan disertai dengan bradikardi.
Ikterus pada kulit dan sklera yang terus meningkat pada minggu I, kemudian
menetap dan baru berkurang setelah 10-14 hari. Kadang-kadang disertai
gatal-gatal pasa seluruh badan, rasa lesu dan lekas capai dirasakan selama 1-2
minggu. </span></div>
<ol start="4" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Fase penyembuhan </span></i></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Dimulai saat
menghilangnya tanda-tanda ikterus, rasa mual, rasa sakit di ulu hati, disusul
bertambahnya nafsu makan, rata-rata 14-15 hari setelah timbulnya masa ikterik.
Warna urine tampak normal, penderita mulai merasa segar kembali, namun lemas
dan lekas capai.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l11 level1 lfo12; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">PATOFOSIOLOGI
</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">Patways
terlampir.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 49.65pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Inflamasi
yang menyebar pada hepar (hepatitis) dapat disebabkan oleh infeksi virus dan
oleh reaksi toksik terhadap obat-obatan dan bahan-bahan kimia. Unit fungsional
dasar dari hepar disebut lobule dan unit ini unik karena memiliki suplai darah
sendiri. Sering dengan berkembangnya inflamasi pada hepar, pola normal pada
hepar terganggu. Gangguan terhadap suplai darah normal pada sel-sel hepar ini
menyebabkan nekrosis dan kerusakan sel-sel hepar. Setelah lewat masanya,
sel-sel hepar yang menjadi rusak dibuang dari tubuh oleh respon sistem imun dan
digantikan oleh sel-sel hepar baru yang sehat. Oleh karenanya, sebagian besar
klien yang mengalami hepatitis sembuh dengan fungsi hepar normal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 49.65pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 1;"> </span>Inflamasi pada hepar karena invasi virus
akan menyebabkan peningkatan suhu badan dan peregangan kapsula hati yang memicu
timbulnya perasaan tidak nyaman pada perut kuadran kanan atas. Hal ini
dimanifestasikan dengan adanya rasa mual dan nyeri di ulu hati.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 49.65pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 1;"> </span>Timbulnya ikterus karena kerusakan sel
parenkim hati. Walaupun jumlah billirubin yang belum mengalami konjugasi masuk
ke dalam hati tetap normal, tetapi karena adanya kerusakan sel hati dan duktuli
empedu intrahepatik, maka terjadi kesukaran pengangkutan billirubin tersebut
didalam hati. Selain itu juga terjadi kesulitan dalam hal konjugasi. Akibatnya
billirubin tidak sempurna dikeluarkan melalui duktus hepatikus, karena terjadi
retensi (akibat kerusakan sel ekskresi) dan regurgitasi pada duktuli, empedu belum
mengalami konjugasi (bilirubin indirek), maupun bilirubin yang sudah mengalami
konjugasi (bilirubin direk). Jadi ikterus yang timbul disini terutama
disebabkan karena kesukaran dalam pengangkutan, konjugasi dan eksresi
bilirubin.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 49.65pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 1;"> </span>Tinja mengandung sedikit sterkobilin oleh
karena itu tinja tampak pucat (abolis). Karena bilirubin konjugasi larut dalam
air, maka bilirubin dapat dieksresi ke dalam kemih, sehingga menimbulkan
bilirubin urine dan kemih berwarna gelap. Peningkatan kadar bilirubin terkonjugasi
dapat disertai peningkatan garam-garam empedu dalam darah yang akan menimbulkan
gatal-gatal pada ikterus.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 49.65pt; text-align: justify;">
<br /></div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 10.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="page-break-before: always;" />
</span></b>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l11 level1 lfo12; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">PEMERIKSAAN DIAGNOSTIK</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 71.85pt; mso-list: l4 level1 lfo15; text-align: justify; text-indent: -50.55pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Laboratorium</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l4 level2 lfo15; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pemeriksaan pigmen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">urobilirubin direk</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">bilirubun serum total</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">bilirubin urine</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">urobilinogen urine</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">urobilinogen feses</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l4 level2 lfo15; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pemeriksaan protein</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">protein totel serum</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">albumin serum</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">globulin serum</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">HbsAG</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l4 level2 lfo15; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Waktu protombin</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">-<span style="mso-spacerun: yes;"> </span>respon waktu protombin terhadap vitamin K </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l4 level2 lfo15; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pemeriksaan serum transferase dan
transaminase</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">AST atau SGOT</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">ALT atau SGPT</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">LDH</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Amonia serum</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 71.85pt; mso-list: l4 level1 lfo15; text-align: justify; text-indent: -50.55pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Radiologi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">foto rontgen abdomen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">pemindahan hati denagn preparat
technetium, emas, atau rose bengal yang berlabel radioaktif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">kolestogram dan kalangiogram</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">arteriografi pembuluh darah seliaka</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 71.85pt; mso-list: l4 level1 lfo15; text-align: justify; text-indent: -50.55pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pemeriksaan
tambahan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">laparoskopi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo16; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">biopsi hati</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l11 level1 lfo12; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">F.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">KOMPLIKASI</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Ensefalopati hepatic
terjadi pada kegagalan hati berat yang disebabkan oleh akumulasi amonia serta metabolik
toksik merupakan stadium lanjut ensefalopati hepatik. Kerusakan jaringan
paremkin hati yang meluas akan menyebabkan sirosis hepatis, penyakit ini lebih
banyak ditemukan pada alkoholik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-family: "Verdana","sans-serif"; font-size: 14.0pt; line-height: 150%;">ASUHAN
KEPERAWATAN</span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.85pt; mso-list: l3 level1 lfo14; tab-stops: list 17.85pt; text-align: justify; text-indent: -17.85pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">PENGKAJIAN</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.85pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Data dasar tergantung
pada penyebab dan beratnya kerusakan/gangguan hati</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.15pt; mso-list: l3 level2 lfo14; text-align: justify; text-indent: -50.85pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Aktivitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kelemahan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kelelahan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Malaise</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";"> </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.15pt; mso-list: l3 level2 lfo14; text-align: justify; text-indent: -50.85pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Sirkulasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Bradikardi
( hiperbilirubin berat )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Ikterik
pada sklera kulit, membran mukosa</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.15pt; mso-list: l3 level2 lfo14; text-align: justify; text-indent: -50.85pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Eliminasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Urine
gelap</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Diare
feses warna tanah liat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.15pt; mso-list: l3 level2 lfo14; text-align: justify; text-indent: -50.85pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Makanan
dan Cairan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Anoreksia</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Berat
badan menurun</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Mual
dan muntah</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Peningkatan
oedema</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Asites</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.15pt; mso-list: l3 level2 lfo14; text-align: justify; text-indent: -50.85pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Neurosensori</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Peka
terhadap rangsang</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Cenderung
tidur</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Letargi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Asteriksis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.15pt; mso-list: l3 level2 lfo14; text-align: justify; text-indent: -50.85pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri
/ Kenyamanan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kram
abdomen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri
tekan pada kuadran kanan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Mialgia</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Atralgia</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Sakit
kepala</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Gatal
( pruritus )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.15pt; mso-list: l3 level2 lfo14; text-align: justify; text-indent: -50.85pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Keamanan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Demam</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Urtikaria</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Lesi
makulopopuler</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Eritema</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Splenomegali</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pembesaran
nodus servikal posterior</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.15pt; mso-list: l3 level2 lfo14; text-align: justify; text-indent: -50.85pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Seksualitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.8pt; mso-list: l3 level3 lfo14; text-align: justify; text-indent: -1.0cm;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ð<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pola
hidup / perilaku meningkat resiko terpajan</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.85pt; mso-list: l3 level1 lfo14; tab-stops: list 17.85pt; text-align: justify; text-indent: -17.85pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">DIAGNOSA
<span style="mso-spacerun: yes;"> </span>KEPERAWATAN </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Beberapa masalah
keperawatan yang mungkin muncul pada penderita hepatitis :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 40.5pt; mso-list: l5 level1 lfo3; tab-stops: list 40.5pt; text-align: justify; text-indent: -22.5pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Perubahan nutrisi kurang dari
kebutuhan tubuh berhubungan dengan, perasaan tidak nyaman di kuadran kanan atas,
gangguan absorbsi dan metabolisme pencernaan makanan, kegagalan masukan untuk
memenuhi kebutuhan metabolik karena anoreksia, mual dan muntah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 40.5pt; mso-list: l5 level1 lfo3; text-align: justify; text-indent: -22.5pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Gangguan rasa nyaman (nyeri)
berhubungan dengan pembengkakan hepar yang mengalami inflamasi hati dan
bendungan vena porta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l5 level1 lfo3; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Hypertermi berhubungan dengan invasi
agent dalam sirkulasi darah sekunder terhadap inflamasi hepar </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l5 level1 lfo3; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Keletihan berhubungan dengan proses
inflamasi kronis sekunder terhadap hepatitis </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l5 level1 lfo3; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Resiko tinggi kerusakan integritas
kulit dan jaringan berhubungan dengan pruritus sekunder terhadap akumulasi
pigmen bilirubin dalam garam empedu </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l5 level1 lfo3; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Risiko tinggi terhadap transmisi
infeksi berhubungan dengan sifat menular dari agent virus </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 35.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l11 level1 lfo12; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">G.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">INTERVENSI
</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo4; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Perubahan
nutrisi kurang dari kebutuhan tubuh</span></i><span style="font-family: "Verdana","sans-serif";">
berhubungan dengan, perasaan tidak nyaman di kuadran kanan atas, gangguan
absorbsi dan metabolisme pencernaan makanan, kegagalan masukan untuk memenuhi kebutuhan
metabolik karena anoreksia, mual dan muntah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Hasil yang diharapkan</span></i><span style="font-family: "Verdana","sans-serif";"> : Menunjukkan peningkatan berat
badan mencapai tujuan dengan nilai laboratorium normal dan bebas dari
tanda-tanda mal nutrisi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l10 level1 lfo5; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Ajarkan dan bantu klien untuk
istirahat sebelum makan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; tab-stops: 35.45pt 70.9pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>keletihan berlanjut menurunkan
keinginan untuk makan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l10 level1 lfo5; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Awasi pemasukan diet/jumlah kalori,
tawarkan makan sedikit tapi sering dan tawarkan pagi paling sering</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>adanya pembesaran hepar dapat
menekan saluran gastro intestinal dan menurunkan kapasitasnya. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l10 level1 lfo5; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pertahankan hygiene mulut yang baik
sebelum makan dan sesudah makan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>akumulasi partikel makanan di
mulut dapat menambah baru dan rasa tak sedap yang menurunkan nafsu makan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l10 level1 lfo5; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Anjurkan makan pada posisi duduk
tegak</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 78.0pt; text-align: justify; text-indent: -24.55pt;">
<span style="font-family: "Verdana","sans-serif";">R/
menurunkan rasa penuh pada abdomen dan dapat meningkatkan pemasukan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l10 level1 lfo5; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Berikan diit tinggi kalori, rendah
lemak </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>glukosa dalam karbohidrat cukup
efektif untuk pemenuhan energi, sedangkan lemak sulit untuk
diserap/dimetabolisme sehingga akan membebani hepar.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo4; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Gangguan
rasa nyaman (nyeri)</span></i><span style="font-family: "Verdana","sans-serif";">
berhubungan dengan pembengkakan hepar yang mengalami inflamasi hati dan
bendungan vena porta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Hasil yang diharapkan :</span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Menunjukkan
tanda-tanda nyeri fisik dan perilaku dalam nyeri (tidak meringis kesakitan,
menangis intensitas dan lokasinya)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; mso-list: l6 level1 lfo6; tab-stops: 35.45pt list 55.7pt; text-align: justify; text-indent: -20.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kolaborasi dengan individu untuk
menentukan metode yang dapat digunakan untuk intensitas nyeri </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<span style="font-family: "Verdana","sans-serif";">R/
nyeri yang berhubungan dengan hepatitis sangat tidak nyaman, oleh karena
terdapat peregangan secara kapsula hati, melalui pendekatan kepada individu
yang mengalami perubahan kenyamanan nyeri diharapkan lebih efektif mengurangi
nyeri.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; mso-list: l6 level1 lfo6; tab-stops: 35.45pt list 55.7pt; text-align: justify; text-indent: -20.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Tunjukkan pada klien penerimaan
tentang respon klien terhadap nyeri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Akui adanya nyeri </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Dengarkan dengan penuh perhatian
ungkapan klien tentang nyerinya </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<span style="font-family: "Verdana","sans-serif";">R/
klienlah yang harus mencoba meyakinkan pemberi pelayanan kesehatan bahwa ia
mengalami nyeri </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; mso-list: l6 level1 lfo6; tab-stops: 35.45pt list 55.7pt; text-align: justify; text-indent: -20.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Berikan informasi akurat dan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Jelaskan penyebab nyeri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Tunjukkan berapa lama nyeri akan
berakhir, bila diketahui </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<span style="font-family: "Verdana","sans-serif";">R/
klien yang disiapkan untuk mengalami nyeri melalui penjelasan nyeri yang
sesungguhnya akan dirasakan (cenderung lebih tenang dibanding klien yang
penjelasan kurang/tidak terdapat penjelasan)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; mso-list: l6 level1 lfo6; tab-stops: 35.45pt list 55.7pt; text-align: justify; text-indent: -20.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Bahas dengan dokter penggunaan
analgetik yang tak mengandung efek hepatotoksi </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<span style="font-family: "Verdana","sans-serif";">R/
kemungkinan nyeri sudah tak bisa dibatasi dengan teknik untuk mengurangi nyeri.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo4; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";"><span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Hypertermi</i>
berhubungan dengan invasi agent dalam sirkulasi darah sekunder terhadap
inflamasi hepar.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Hasil yang diharapkan : </span></i><span style="font-family: "Verdana","sans-serif";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Tidak
terjadi peningkatan suhu</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo8; tab-stops: 35.45pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Monitor tanda vital : suhu badan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 35.45pt 70.9pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">R/
sebagai indikator untuk mengetahui status hypertermi </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo8; tab-stops: 35.45pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Ajarkan klien pentingnya
mempertahankan cairan yang adekuat (sedikitnya 2000 l/hari) untuk mencegah
dehidrasi, misalnya sari buah 2,5-3 liter/hari.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -16.9pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-spacerun: yes;"> </span>dalam kondisi demam terjadi peningkatan
evaporasi yang memicu timbulnya dehidrasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -16.9pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -16.9pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -16.9pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo8; tab-stops: 35.45pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Berikan kompres hangat pada lipatan
ketiak dan femur </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -16.9pt;">
<span style="font-family: "Verdana","sans-serif";">R/
menghambat pusat simpatis di hipotalamus sehingga terjadi vasodilatasi kulit
dengan merangsang kelenjar keringat untuk mengurangi panas tubuh melalui
penguapan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo8; tab-stops: 35.45pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Anjurkan klien untuk memakai pakaian
yang menyerap keringat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.05pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>kondisi kulit yang mengalami
lembab memicu timbulnya pertumbuhan jamur. Juga akan mengurangi kenyamanan
klien, mencegah timbulnya ruam kulit.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.05pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo4; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Keletihan</span></i><span style="font-family: "Verdana","sans-serif";"> berhubungan dengan proses inflamasi
kronis sekunder terhadap hepatitis </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l12 level1 lfo9; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Jelaskan sebab-sebab keletihan
individu </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif";">R/
dengan penjelasan sebab-sebab keletihan maka keadaan klien cenderung lebih
tenang </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l12 level1 lfo9; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Sarankan klien untuk tirah baring </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>tirah baring akan meminimalkan
energi yang dikeluarkan sehingga metabolisme dapat digunakan untuk penyembuhan
penyakit.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l12 level1 lfo9; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Bantu individu untuk
mengidentifikasi kekuatan-kekuatan, kemampuan-kemampuan dan minat-minat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -16.9pt;">
<span style="font-family: "Verdana","sans-serif";">R/
memungkinkan klien dapat memprioritaskan kegiatan-kegiatan yang sangat penting
dan meminimalkan pengeluaran energi untuk kegiatan yang kurang penting</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l12 level1 lfo9; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Analisa bersama-sama tingkat
keletihan selama 24 jam meliputi waktu puncak energi, waktu kelelahan,
aktivitas yang berhubungan dengan keletihan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 78.0pt; tab-stops: 35.45pt; text-align: justify; text-indent: -21.3pt;">
<span style="font-family: "Verdana","sans-serif";">R/
keletihan dapat segera diminimalkan dengan mengurangi kegiatan yang dapat
menimbulkan keletihan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l12 level1 lfo9; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Bantu untuk belajar tentang
keterampilan koping yang efektif (bersikap asertif, teknik relaksasi)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; tab-stops: 35.45pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">R/ untuk
mengurangi keletihan baik fisik maupun psikologis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; tab-stops: 35.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; tab-stops: 35.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo4; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Resiko
tinggi kerusakan integritas kulit dan jaringan</span></i><span style="font-family: "Verdana","sans-serif";"> berhubungan dengan pruritus
sekunder terhadap akumulasi pigmen bilirubin dalam garam empedu </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Hasil yang diharapkan :</span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Jaringan
kulit utuh, penurunan pruritus.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l14 level1 lfo10; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pertahankan kebersihan tanpa
menyebabkan kulit kering </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Sering mandi dengan menggunakan air
dingin dan sabun ringan (kadtril, lanolin)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Keringkan kulit, jaringan digosok </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<span style="font-family: "Verdana","sans-serif";">R/
kekeringan meningkatkan sensitifitas kulit dengan merangsang ujung syaraf</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l14 level1 lfo10; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Cegah penghangatan yang berlebihan
dengan pertahankan suhu ruangan dingin dan kelembaban rendah, hindari pakaian
terlalu tebal</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>penghangatan yang berlebih
menambah pruritus dengan meningkatkan sensitivitas melalui vasodilatasi </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l14 level1 lfo10; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Anjurkan tidak menggaruk,
instruksikan klien untuk memberikan tekanan kuat pada area pruritus untuk
tujuan menggaruk </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>penggantian merangsang pelepasan
hidtamin, menghasilkan lebih banyak pruritus</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 53.45pt; mso-list: l14 level1 lfo10; tab-stops: 35.45pt list 53.45pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pertahankan kelembaban ruangan pada
30%-40% dan dingin </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif";">R/
<span style="mso-tab-count: 1;"> </span>pendinginan akan menurunkan
vasodilatasi dan kelembaban kekeringan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo4; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pola nafas tidak efektif berhubungan
dengan pengumpulan cairan intraabdomen, asites penurunan ekspansi paru dan
akumulasi sekret.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Hasil yang diharapkan :</span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Pola
nafas adekuat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Intervensi
:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l9 level1 lfo13; tab-stops: 35.45pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Awasi frekwensi , kedalaman dan
upaya pernafasan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">R/ pernafasan
dangkal/cepat kemungkinan terdapat hipoksia atau akumulasi cairan dalam abdomen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l9 level1 lfo13; tab-stops: 35.45pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Auskultasi bunyi nafas tambahan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: 21.25pt;">
<span style="font-family: "Verdana","sans-serif";">R/
kemungkinan menunjukkan adanya akumulasi cairan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l9 level1 lfo13; tab-stops: 35.45pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Berikan posisi semi fowler</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">R/ memudahkan pernafasan
denagn menurunkan tekanan pada diafragma dan meminimalkan ukuran sekret</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l9 level1 lfo13; tab-stops: 35.45pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Berikan latihan nafas dalam dan
batuk efektif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 42.55pt; tab-stops: 1.0cm; text-align: justify; text-indent: 14.15pt;">
<span style="font-family: "Verdana","sans-serif";">R/
membantu ekspansi paru dalam memobilisasi lemak</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l9 level1 lfo13; tab-stops: 35.45pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Berikan oksigen sesuai kebutuhan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; tab-stops: 35.45pt 60.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">R/
mungkin perlu untuk mencegah hipoksia<span style="mso-tab-count: 2;"> </span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo4; tab-stops: 35.45pt; text-align: justify; text-indent: -17.45pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Risiko
tinggi</span></i><span style="font-family: "Verdana","sans-serif";"> <i style="mso-bidi-font-style: normal;">terhadap transmisi infeksi</i> berhubungan
dengan sifat menular dari agent virus </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";">Hasil yang diharapkan : </span></i></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 35.45pt; text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 1;"> </span></span></i><span style="font-family: "Verdana","sans-serif";">Tidak menunjukkan tanda-tanda infeksi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; mso-list: l15 level1 lfo11; tab-stops: 35.45pt list 55.7pt; text-align: justify; text-indent: -20.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Gunakan kewaspadaan umum terhadap
substansi tubuh yang tepat untuk menangani semua cairan tubuh </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Cuci tangan sebelum dan sesudah
kontak dengan semua klien atau spesimen </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Gunakan sarung tangan untuk kontak
dengan darah dan cairan tubuh </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 73.7pt; mso-list: l1 level1 lfo7; tab-stops: 35.45pt list 73.7pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Tempatkan spuit yang telah digunakan
dengan segera pada wadah yang tepat, jangan menutup kembali atau memanipulasi
jarum dengan cara apapun </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<span style="font-family: "Verdana","sans-serif";">R/
pencegahan tersebut dapat memutuskan metode transmisi virus hepatitis </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; mso-list: l15 level1 lfo11; tab-stops: 35.45pt list 55.7pt; text-align: justify; text-indent: -20.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Gunakan teknik pembuangan sampah
infeksius, linen dan cairan tubuh dengan tepat untuk membersihkan
peralatan-peralatan dan permukaan yang terkontaminasi </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<span style="font-family: "Verdana","sans-serif";">R/
teknik ini membantu melindungi orang lain dari kontak dengan materi infeksius
dan mencegah transmisi penyakit </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; mso-list: l15 level1 lfo11; tab-stops: 35.45pt list 55.7pt; text-align: justify; text-indent: -20.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Jelaskan pentingnya mencuci tangan
dengan sering pada klien, keluarga dan pengunjung lain dan petugas pelayanan
kesehatan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; tab-stops: 35.45pt; text-align: justify; text-indent: -15.2pt;">
<span style="font-family: "Verdana","sans-serif";">R/
mencuci tangan menghilangkan organisme yang merusak rantai transmisi infeksi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; mso-list: l15 level1 lfo11; tab-stops: 35.45pt list 55.7pt; text-align: justify; text-indent: -20.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Rujuk ke petugas pengontrol infeksi
untuk evaluasi departemen kesehatan yang tepat </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 55.7pt; tab-stops: 35.45pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">R/
rujukan tersebut perlu untuk mengidentifikasikan sumber pemajanan dan
kemungkinan orang lain terinfeksi </span></div>
<span style="font-family: "Verdana","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 10.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="page-break-before: always;" />
</span>
<div align="center" class="MsoNormal" style="line-height: 150%; tab-stops: 35.45pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Verdana","sans-serif";">DAFTAR PUSTAKA </span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; tab-stops: 35.45pt; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Carpenito
Lynda Jual, 1999, <i style="mso-bidi-font-style: normal;">Rencana Asuhan dan
Dokumentasi Keperawatan, </i>EGC, Jakarta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Gallo,
Hudak, 1995, <i style="mso-bidi-font-style: normal;">Keperawatan Kritis, </i>EGC,
Jakarta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Hadim
Sujono, 1999, <i style="mso-bidi-font-style: normal;">Gastroenterologi,</i>
Alumni Bandung.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Moectyi,
Sjahmien, 1997, <i style="mso-bidi-font-style: normal;">Pengaturan Makanan dan
Diit untuk Pertumbuhan Penyakit, </i>Gramedia Pustaka Utama Jakarta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Price,
Sylvia Anderson, Wilson, Lorraine Mc Carty, 1995, <i style="mso-bidi-font-style: normal;">Patofisiologi Konsep Klinis Proses-proses Penyakit,</i> EGC, Jakarta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Smeltzer,
suzanna C, <i style="mso-bidi-font-style: normal;">Buku Ajar Keperawatan Medikal
Bedah</i>. Brunner dan Suddart. Alih bahasa Agung Waluyo, Edisi 8, jakarta, EGC, 2001.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Susan,
Martyn Tucker et al, <i style="mso-bidi-font-style: normal;">Standar Perawatan
Pasien</i>, jakarta,
EGC, 1998.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Reeves,
Charlene, et al,<i style="mso-bidi-font-style: normal;">Keperawatan Medikal Bedah</i>,
Alih bahasa Joko Setiyono, Edisi I, jakarta, Salemba Medika.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 35.45pt; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Verdana","sans-serif";">Sjaifoellah
Noer,H.M, 1996, <i style="mso-bidi-font-style: normal;">Buku Ajar Ilmu Penyakit
Dalam</i>, jilid I, edisi ketiga, Balai Penerbit FKUI, jakarta.</span></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-32120860837315066262011-11-10T07:22:00.001-08:002011-11-10T07:22:43.379-08:00BPH<!--[if gte mso 9]><xml>
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<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b><span style="font-family: "Lucida Handwriting"; font-size: 18.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">BENIGN PROSTATIC HIPERPLASI ( BPH )</span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<h5 style="line-height: normal;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">A. DEFINISI</span></h5>
<div class="MsoBodyText" style="text-indent: 36.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">BPH adalah kondisi
patologis yang paling umum pada pria lansia dan penyebab paling sering untuk
intervensi medis pada pria di atas usia 60 tahun. </span><i><span style="font-family: "Tempus Sans ITC"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;">(Smeltzer
: 2001 ; 1625).</span></i></div>
<div class="MsoBodyText">
<br /></div>
<h5 style="line-height: normal;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">B. ETIOLOGI</span></h5>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Belum
diketahui secara pasti penyebab terjadinya hiperplasi prostat. Tetapi beberapa
hipotesis yang erat kaitannya dengan hiperplasi prostat adalah :</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Peningkatan kadar dihidrotestoteron dan
proses aging (menjadi tua)</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Adanya ketidakseimbnagan estrogen –
progesterone</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Interaksi antara sel stroma dan sel
epitel prostat</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Berkurangnya kematian sel</span></div>
<ol start="5" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Teori stem sel<span style="mso-spacerun: yes;"> </span></span><i><span style="font-family: "Tempus Sans ITC"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>( Purnomo : 2003 ; 70 )</span></i><i><span style="font-family: "Comic Sans MS"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;"></span></i></li>
</ol>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<br /></div>
<h5 style="line-height: normal;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">C. PATOFISIOLOGI</span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"></span></h5>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Pembesaran
prostat menyebabkan penyempitan lumen uretra prostatika dan menghambat aliran
urine. Keadaan ini menyebabkan peningkatan tekanan intravesika. Untuk
mengeluarkan urine, buli –buli harus berkontraksi lebih kuat guna melawan
tahanan itu. Kontraksi yang ters-menerus ini menyebabkan perubahan anatomic
buli-buli berupa hipertropi otot destrusor, trabekulasi, terbentuknya selula,
sakula, dan divertikel buli-buli. Perubahan struktur pada buli-buli tersebut,
oleh pasien dirasakan sebagai keluhan pada saluran kemih bagian bawah atau
lower urinary truct system ( LUTS ) yang dahulu dikenal dengan gejala
prostatismus.</span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tekanan
intravesikal yang tinggi diteruskan ke seluruh bagian buli-buli tidak
terkecuali pada kedua muara ureter. Tekanan pada muara ureter ini dapat
menimbulkan aliran balik urine dari buli-buli ke ureter atau terjadi refluk
vesikoureter. Keadaan ini jika berlangsung terus-menerus mengakibatkan
hidroureter, hidronefrosis, bahkan akhirnya dapat jatuh ke dalam gagal ginjal.</span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Obstruksi
yang diakibatkan oleh hiperplasia prostat benigna tidak hanya disebabkan oleh
adanya massa prostat yang menyumbat uretra posterior, tetapi juga disebabkan
oleh tonus otot polos yang ada pada stroma prostat, kapsul prostat, dan otot
polos pada leher buli-buli. Otot polos itu dipersarafi oleh serabut simpatis
yang berasal dari nervus pudendus.</span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Pada
BPH terjadi rasio peningkatan komponen stroma terhadap epitel. Kalau pada
prostat normal rasio stroma disbanding dengan epitel adalah 2:1, pada BPH
meningkat menjadi 4:1, hal ini menyebabkan pada BPH terjadi peningkatan tonus
otot polos prostat dibandigkan dengan prostat normal. Dalam hal ini massa prostat
yang menyebabkan komponen static sedangkan tonus otot polos yang merupakan
komponen dinamik sebagai penyebab obstruksi prostat. </span><i><span style="font-family: "Tempus Sans ITC"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;">(
Purnomo : 2003 ; 72 )</span></i><i><span style="font-family: "Comic Sans MS"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;"></span></i></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<br /></div>
<h5 style="line-height: normal;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">D. MANIFESTASI KLINIS</span></h5>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Komplek
gejala obstruktif dan iritatif (Prostatisme) mencakup :</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Peningkatan
frekuensi berkemih</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Nocturia</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Dorongan
ingin berkemih, anyang-anyangan</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Abdomen
tegang</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Penurunan
volume urine dan harus mengejan saat berkemih</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Urine
terus menetes setelah berkemih ( dribbling )</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Retensi
urine, kekambuhan ISK ( Infeksi Saluran Kemih )</span></div>
<ul style="margin-top: 0cm;" type="square">
<li class="MsoNormal" style="mso-list: l13 level1 lfo2; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Anureksia, mual muntah, rasa tidak
nyaman pada epigastrik. </span><i><span style="font-family: "Tempus Sans ITC"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;">( Smeltzer : 2001
; 1625 )</span></i></li>
</ul>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<br /></div>
<h5 style="line-height: normal;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">E. PEMERIKSAAN PENUNJANG</span></h5>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Urinalisa<span style="mso-tab-count: 1;"> </span>: warna , PH urine, dan menunjukkan infeksi. </span></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Kultur
urine<span style="mso-tab-count: 1;"> </span>: menunjukkan stapilococcus
aureus, proteus, klebsiela, pseudomonas, atau escherichia coli.</span></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">BUN/kreatinin</span></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">IVP
( intra venous pielography )<span style="mso-tab-count: 1;"> </span>:
menunjukkan perlambatan penosongan kandung kemih.</span></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Sistouretroskopi<span style="mso-tab-count: 1;"> </span>: penggambaran derajat pembesaran
prostat.</span></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Sistometri
: mengevaluasi fungsi otot destrusor dan tonusnya.</span></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l3 level1 lfo3; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Ultrasound
transrektal : mengetahui ukuran prostat, jumlah residu. </span><i><span style="font-family: "Tempus Sans ITC"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;">(
Doenges : 1999<span style="mso-spacerun: yes;"> </span>; 672</span></i><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">
)</span></div>
<div class="MsoNormal" style="margin-left: 22.5pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: "Lucida Handwriting"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">F.</span></b><span style="font-family: "Comic Sans MS"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">
</span><b><span style="font-family: "Lucida Handwriting"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">PENATALAKSANAAN</span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 31.5pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tujuan
penatalaksanaan adalah :</span></div>
<div class="MsoHeading8" style="tab-stops: list 21.6pt;">
<span style="font-family: "Tempus Sans ITC"; mso-bidi-font-family: "Tempus Sans ITC"; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">1<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC";">Memperbaiki
keluhan miksi</span></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l10 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">2<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Meningkatkan kualitas hidup</span></div>
<h6 style="margin-left: 49.5pt; mso-list: l10 level1 lfo4; tab-stops: list 21.6pt;">
<span style="font-family: "Tempus Sans ITC"; mso-bidi-font-family: "Tempus Sans ITC"; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">3<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC";">Mengurangi obstruksi intravesika</span></h6>
<div class="MsoHeading8" style="tab-stops: list 21.6pt;">
<span style="font-family: "Tempus Sans ITC"; mso-bidi-font-family: "Tempus Sans ITC"; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">4<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC";">Menurunkan volume residu urine setelah
miksi</span></div>
<div class="MsoNormal" style="margin-left: 49.5pt; mso-list: l10 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">5<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Mencegah progesifitas penyakit</span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoHeading7">
<b><i><span style="font-family: "Tempus Sans ITC";">Pilihan
penatalaksanaan BPH</span></i></b></div>
<div class="MsoNormal">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt;">
<tbody>
<tr style="height: 53.1pt;">
<td style="border: solid windowtext 1.0pt; height: 53.1pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.55pt;" valign="top" width="143">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Observasi</span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 53.1pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.6pt;" valign="top" width="143">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Medikamentosa</span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 53.1pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.6pt;" valign="top" width="143">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Operasi</span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; height: 53.1pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.6pt;" valign="top" width="143">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Invansif
minimal</span></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.55pt;" valign="top" width="143">
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Watchful waiting</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.6pt;" valign="top" width="143">
<div class="MsoNormal" style="tab-stops: 13.9pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">-penghambat
adrenergik_a</span></div>
<div class="MsoNormal" style="margin-left: 9.4pt; mso-list: l13 level2 lfo2; text-align: justify; text-indent: -10.65pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Penghambat
reduktase_a</span></div>
<div class="MsoNormal" style="margin-left: 4.9pt; mso-list: l13 level2 lfo2; tab-stops: list .4pt; text-align: justify; text-indent: -4.5pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Fitoterapi</span></div>
<div class="MsoNormal" style="margin-left: 13.95pt; mso-list: l13 level2 lfo2; text-align: justify; text-indent: -10.15pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Hormonal</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.6pt;" valign="top" width="143">
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l5 level2 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Prostatektomi</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l5 level2 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Endourologi</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l13 level2 lfo2; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">TURP</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l13 level2 lfo2; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">TUIP</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l13 level2 lfo2; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">TULP</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 107.6pt;" valign="top" width="143">
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo6; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">TUMT</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo6; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">TUBD</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo6; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Stent
uretra</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo6; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">TUNA</span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Comic Sans MS"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span></span><i><span style="font-family: "Comic Sans MS"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;">( Purnomo : 2003 ; 78 )</span></i></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<h4>
<b>PROSES KEPERAWATAN</b></h4>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l8 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<b><i><span style="font-family: "Comic Sans MS"; font-size: 16.0pt; mso-bidi-font-family: "Comic Sans MS"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Comic Sans MS";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><b><i><span style="font-family: "Comic Sans MS"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">PENGKAJIAN</span></i></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level3 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Apakah
pasien cukup aktif untuk usianya</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level3 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Penurunan
aliran urine</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level3 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Penurunan
kemampuan untuk berkemih</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level3 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Sering
berkemih, disuria dan hematuria</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level3 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Nyeri
pinggang dan punggung</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level3 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Ketidaknyaman
abdomen dan supra pubis</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level3 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Riwayat
keluarga mengenai kanker dan gagal ginjal</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level3 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 16.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Penurunan
BB</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l8 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<b><i><span style="font-family: "Comic Sans MS"; font-size: 16.0pt; mso-bidi-font-family: "Comic Sans MS"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Comic Sans MS";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><b><i><span style="font-family: "Comic Sans MS"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">DIAGNOSA
KEPERAWATAN & INTERVENSI</span></i></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Menurut
Doenges ( 1999 : 673-685)</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l7 level3 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">i)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Retensi urine (akut/kronik) b/d obstruksi
mekanik, pembesaran prostat.</span></div>
<div class="MsoBodyTextIndent3">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tujuan<span style="mso-tab-count: 2;"> </span>:
Pasien mampu mengosongkan kandung kemih dengan lengkap</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Intervensi
<span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l8 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Dorong pasien untuk berkemih tiap 2-4 jam</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l8 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Observasi aliran urine</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l8 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Pertahankan intake dan output cairan
sampai 3000L</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l8 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Awasi TTV</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l8 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Berikan obat sesuai dengan indikasi</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l7 level3 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">ii)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Nyeri b/d iritasi mukosa, distensi
kandung kemih.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tujuan<span style="mso-tab-count: 2;"> </span>: Nyeri berkurang</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Intervensi<span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l6 level1 lfo10; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Kaji nyeri,lokasi,dan karakteristik</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l6 level1 lfo10; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Berikan tindakan yang nyaman</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l6 level1 lfo10; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Pasang kateter</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l6 level1 lfo10; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Berikan obat sesuai dengan indikasi ;
narkotik</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l6 level1 lfo10; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Antispasmodic dan sedatif</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l7 level3 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">iii)</span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Kekurangan
volume cairan b/d disfungsi ginjal</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tujuan
<span style="mso-tab-count: 2;"> </span>: Tidak terjadi kekurangan
volume cairan</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Intervensi<span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level1 lfo11; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Awasi intake dan output cairan</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level1 lfo11; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Awasi elektrolit terutama natrium</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level1 lfo11; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Anjurkan untuk penngkatan pemasukan oral</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l1 level1 lfo11; text-align: justify; text-indent: 0cm;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Beri cairan IV sesuai dengan kebutuhan</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l7 level3 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">iv)</span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Ancietas b/d prosedur
pembedahan</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tujuan<span style="mso-tab-count: 2;"> </span>: Pasien tampak rilek</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Intervensi<span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l11 level1 lfo12; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Bina hubungan saling percaya dengan
pasien/kelurga</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l11 level1 lfo12; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Berikan informasi tentang prosedur dan
tes yang akan dilakukan</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l11 level1 lfo12; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Dorong pasien/keluarga untuk mengatakan
masalah</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l11 level1 lfo12; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Beri penguatan informasi yang telah
diberikan.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l7 level3 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">v)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Perubahan eliminasi urin b/d bekuan
darah, trauma, prosedur bedah.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tujuan<span style="mso-tab-count: 2;"> </span>: Pasien berkemih dengan jumlah
normal tanpa retensi</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Intervensi<span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l14 level1 lfo13; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Kaji keluaran urine dan system kateter</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l14 level1 lfo13; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Bantu pasien memilih posisi normal untuk
berkemih</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l14 level1 lfo13; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Anjurkan pasien untuk berkemih bila ada
dorongan</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l14 level1 lfo13; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Anjurkan pasien untuk meningkatkan intake
cairan 3000 L</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l14 level1 lfo13; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Pertahankan irigasi kandung kemih</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l7 level3 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">vi)</span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Resti infeksi b/d
prosedur invansif, irigasi kandung kemih.</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tujuan
<span style="mso-tab-count: 2;"> </span>: tidak terdapat tanda-tanda
infeksi</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Intervensi<span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l4 level1 lfo14; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Pertahankan kateter steril</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l4 level1 lfo14; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Awasi TTV</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l4 level1 lfo14; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Observasi drainase luka</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l4 level1 lfo14; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Ganti balutan sering dengan prinsip
steril</span></div>
<div class="MsoNormal" style="margin-left: 90.0pt; mso-list: l4 level1 lfo14; text-align: justify; text-indent: -36.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Berikan antibiotik sesuai indikasi</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l7 level3 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-family: "Tempus Sans ITC"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Tempus Sans ITC";"><span style="mso-list: Ignore;">vii)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Resti disfungsi seksual b/d situasi
krisis ( incontinensia urine, keterlibatan area genital )</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Tujuan
<span style="mso-tab-count: 2;"> </span>: tidak ditemukan tanda-tanda
disfungsi seksual dan pasien melaporkan ansietas menurun</span></div>
<div class="MsoBodyTextIndent3">
<span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Intervensi<span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Berikan pada pasien keterbukaan</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Berikan informasi akurat tentang harapan
kembalinya fungsi seksual</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Diskusikan dasar anatomi dan jujur
menjawab pertanyaan pasien</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Diskusikan ejakulasi retrograd bila
dilakukan transuretral</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level1 lfo15; text-align: justify; text-indent: -18.0pt;">
<span style="font-size: 16.0pt; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Tempus Sans ITC"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">Rujuk ke penasehat seksual sesuai
indikasi</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l8 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<b><i><span style="font-family: "Comic Sans MS"; font-size: 16.0pt; mso-bidi-font-family: "Comic Sans MS"; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Comic Sans MS";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><b><i><span style="font-family: "Comic Sans MS"; font-size: 16.0pt; mso-bidi-font-size: 12.0pt;">EVALUASI</span></i></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
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<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-69793502481078087102011-11-10T07:20:00.001-08:002011-11-10T07:20:36.816-08:00ASMA BRONCHIALE<!--[if !mso]>
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<span style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">ASUHAN
KEPERAWATAN</span></div>
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<span style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">PADA
KLIEN DENGAN ASMA BRONCHIALE YANG MENGALAMI GAGAL NAFAS</span></div>
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<b><span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b>DEFINISI</b></div>
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<b><span style="mso-tab-count: 1;"> </span></b>Asma
adalah penyakit jalan nafas obstruktif intermiten, reversibel dimana trakea dan
bronchi berspon dalam secaa hiperaktif terhadap stimuli tertentu.</div>
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<span style="mso-tab-count: 1;"> </span>(
Smeltzer,<span style="mso-spacerun: yes;"> </span>C . Suzanne, 2002, hal 611)</div>
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<br /></div>
<h1 style="line-height: 150%; margin-left: 18.7pt; tab-stops: 18.7pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";"> </span></span>PENYEBAB</h1>
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<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Alergen ; makanan, debu rumah, bulu binatang</div>
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<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Infeksi : virus, bakteri, jamur, parasit</div>
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<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Iritan : minyak wangi, asap rokok, polutan udara, bau
tajam</div>
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<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Cuaca : perubahan tekanan udara, suhu, amgin, dan
kelembaban udara</div>
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<b>Faktor pencetus</b>:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l0 level4 lfo1; tab-stops: 37.4pt list 144.0pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kegiatan jasmani : kegiatan jasmani yang berat seperti:
berlari, naik sepeda</div>
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<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Psikologis seperti stress</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; tab-stops: 18.7pt 46.75pt; text-align: justify;">
<span style="mso-spacerun: yes;"> </span>(
Ngastiyah, 1997, hal 67-68)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; tab-stops: 18.7pt 46.75pt; text-align: justify;">
<br /></div>
<h1 style="line-height: 150%; text-align: justify;">
<span style="mso-list: Ignore;">III.<span style="font: 7.0pt "Times New Roman";">
</span></span>TANDA DAN GEJALA</h1>
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<b><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b><span style="mso-spacerun: yes;"> </span>Stadium dini </b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; text-align: justify;">
<b>Faktor hipersekresi yang lebih menonjol</b></div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Batuk dengan dahak bisa dengan maupun tanpa pilek</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Rochi basah halus pada serangan kedua atau ketiga,
sifatnya hilang timbul</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 180.0pt; mso-list: l0 level5 lfo1; tab-stops: list 56.1pt; text-align: justify; text-indent: -133.25pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Whezing belum ada</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Belum ada kelainan bentuk thorak</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Ada peningkatan eosinofil darah dan IG E</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>BGA belum patologis</div>
<h2 style="line-height: 150%; text-align: justify;">
Faktor spasme bronchiolus dan
edema yang lebih dominan</h2>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Timbul sesak napas dengan atau tanpa sputum</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Whezing</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 180.0pt; mso-list: l0 level5 lfo1; tab-stops: list 65.45pt; text-align: justify; text-indent: -133.25pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Ronchi basah bila terdapat hipersekresi</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Penurunan tekanan parsial O2</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l0 level4 lfo1; tab-stops: list 37.4pt; text-align: justify; text-indent: -18.7pt;">
<b><span style="mso-list: Ignore;">b.</span></b><b>Stadium lanjut/kronik</b></div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Batuk, ronchi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l0 level5 lfo1; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Sesak nafas berat dan dada seolah –olah tertekan</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Dahak lengket dan sulit untuk dikeluarkan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l0 level5 lfo1; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Suara nafas melemah bahkan tak terdengan (silent Chest)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l0 level5 lfo1; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Thorak seperti barel chest</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l0 level5 lfo1; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Tampak tarikan otot sternokleidomastoideus</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Sianosis</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l0 level5 lfo1; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>BGA Pa o2 kurang dari 80%</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l0 level5 lfo1; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Ro paru terdapat peningkatan gambaran bronchovaskuler
kanan dan kiri</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hipokapnea dan alkalosis bahkan asidosis respiratorik</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-align: justify;">
<span style="mso-spacerun: yes;"> </span>(Halim Danukusumo, 2000, hal
218-229)</div>
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<br /></div>
<h1 style="line-height: 150%; text-align: justify;">
<span style="mso-list: Ignore;">IV.<span style="font: 7.0pt "Times New Roman";">
</span></span>PATHWAYS</h1>
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<b><span style="mso-list: Ignore;">V.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b>PEMERIKSAAN PENUNJANG</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l0 level4 lfo1; tab-stops: 46.75pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Spirometri</div>
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<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemeriksaan sputum</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l0 level4 lfo1; tab-stops: 46.75pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemeriksaaan eosinofil total</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l0 level4 lfo1; tab-stops: 46.75pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Uji kulit</div>
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<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemeriksaan<span style="mso-spacerun: yes;">
</span>kadar Ig E<span style="mso-spacerun: yes;"> </span>total dan Ig E
specifik dalam sputum</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l0 level4 lfo1; tab-stops: 46.75pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Foto thorak</div>
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<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>AGD</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; tab-stops: 46.75pt; text-align: justify;">
<br /></div>
<h1 style="line-height: 150%; text-align: justify;">
<span style="mso-list: Ignore;">VI.<span style="font: 7.0pt "Times New Roman";">
</span></span>FOKUS PENGKAJIAN</h1>
<h3 style="line-height: 150%; tab-stops: list 28.05pt left 46.75pt; text-align: justify; text-indent: 0cm;">
<span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";">
</span></span>PENGKAJIAN PRIMER</h3>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Airway</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
Krekels, ronkhi, batuk keras, kering/produktif</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
Penggunaan otot –otot aksesoris pernapasan ( retraksi interkosta)</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Breathing</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
Perpanjangan ekspirasi , mengi, perpendekan periode inspirasi, sesak
napfas, hipoksia</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Circulation</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
Hipotensi, diaforesis, sianosis, pulsus paradoxus > 10 mm</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<br /></div>
<h3 style="line-height: 150%; tab-stops: list 28.05pt 46.75pt left 65.45pt; text-align: justify; text-indent: 0cm;">
<span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";">
</span></span>PENGKAJIAN SEKUNDER</h3>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat penyakit sebelumnya</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; tab-stops: list 54.0pt 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-tab-count: 2;"> </span>Alergi, batuk pilek, menderita penyakit infeksi saluran nafas
bagian atas</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat perawatan keluarga</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; tab-stops: list 65.45pt; text-align: justify;">
<span style="mso-tab-count: 1;"> </span>Adakah
riwayat penyakit asma pada keluarga</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat sosial ekonomi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; tab-stops: list 65.45pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-tab-count: 1;"> </span>Jenis pekerjaan dan waktu luang, jenis makanan yang berhubungan
dengan alergen, hewan piaraan, lingkungan tempat tinggal dan stressor emosi</div>
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<br /></div>
<h1 style="line-height: 150%; text-align: justify;">
<span style="mso-list: Ignore;">VII.<span style="font: 7.0pt "Times New Roman";">
</span></span>DIAGNOSA KEPERAWATAN YANG MUNCUL</h1>
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<b><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b>Tidak
efektifnya bersihan jalan nafas b. d bronkospasme, peningkatan produksi sekret,
sektet kental</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Tujuan: bersihan jalan nafas efektif</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
KH: </div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Bunyi nafas bersih</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Batuk efektif/mengeluarkan dahak</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; text-align: justify;">
Intervensi:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l0 level5 lfo1; tab-stops: list 46.75pt; text-align: justify; text-indent: -9.35pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Ausultasi bunyi nafas, catat adanya bunyi nafas
tambahan misalnya: mengi, krekel, ronchi</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji frekuensi dispnea: gelisah, ansietas distress
pernapasan, penggunan otot bantu</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Beri klien posisi yang nyaman misalnya peninggian empat
tidur, duduk (fowler)</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Pertahankan/ bantu batuk efektif</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Observasi karakteristik batuk</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Tingkatkan masukan cairan sampai 3000 ml/hari dan
berikan air hangat</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan obat sesuai indikasi</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Kolaborasi pengambilan bahan lab : Hb, Ht, leukosit,
foto thorak</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l0 level3 lfo1; tab-stops: list 46.75pt; text-align: justify; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span><b>Ketidakefektifan pola nafas berhubungan dengan
penurunan ekspansi paru selama serangan akut</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Tujuan: pola nafas efektif</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Kriteria hasil:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Sesak berkurang atau hilang</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>RR 18-24x/menit</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Tidak ada retraksi otot pernapasan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Intervensi:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji tanda dan gejala ketidakefektifan pernapasan :
dispnea, penggunaan otot-otot pernapasan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Pantau tanda- tanda vital dan gas- gas dalam arteri</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Baringkan pasien dalam posisi fowler tinggi untuk
memaksimalkan ekspansi dada</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan terapi oksigen sesuai pesanan</div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l0 level3 lfo1; tab-stops: list 46.75pt; text-align: justify; text-indent: -18.7pt;">
<b><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b>Cemas b.d krisis situasi</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-align: justify;">
Tujuan : cemas berkurang/ hilang</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-align: justify;">
KH:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien tampak rileks</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien menyatakansesak berkurang</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Tanda – tanda vital normal</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
Intervensi;</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji tingkat kecemasan klien</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Observasi respon non verbal (gelisah)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Ukur tanda-tanda vital</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Dengarkan keluhan klien dengan empati</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Jelaskan informasi yang diperlukan klien tentang
penyakitnya, perawatan dan pengobatannya</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Ajarkan klien tehnik relaksasi (memejamkan mata,
menarik nafas panjang)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Menganjurkan klien untuk istirahat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
(Tucker S. Martin,<span style="mso-spacerun: yes;">
</span>1998 hal 242-243)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<h4>
DAFTAR PUSTAKA</h4>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
Halim Danukusantoso, <b>Buku Saku
Ilmu Penyakit Paru</b>, Jakarta, Penerbit Hipokrates , 2000</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0cm; text-align: justify;">
Smeltzer,<span style="mso-spacerun: yes;"> </span>C . Suzanne,dkk, <b>Buku Ajar keperawatan
Medikal Bedah</b>, Edisi 8 Vol 1. Jakarta , EGC,<span style="mso-spacerun: yes;"> </span>2002</div>
<div class="MsoNormal" style="tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0cm; text-align: justify;">
Ngastiyah, <b>Perawatan
Anak Sakit</b>, Jakarta, EGC, 1997</div>
<div class="MsoNormal" style="tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0cm; text-align: justify;">
Hudak & Gallo, <b>Keperawatan
Kritis</b>, Edisi VI,Vol I, Jakarta, EGC, 2001</div>
<div class="MsoNormal" style="tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 54.0pt; text-align: justify;">
Tucker
S. Martin,<span style="mso-spacerun: yes;"> </span><b>Standart Perawatan Pasien</b>,
Jilid 2, Jakarta, EGC, 1998 </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify;">
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<h5 style="text-align: justify;">
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<span style="font-size: 8.0pt; mso-bidi-font-size: 12.0pt;">Intrinsik
(infeksi, psikososial, stress)</span></div>
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</tr>
</tbody></table>
</span> </td>
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</tbody></table>
</span>PATHWAYS ASMA BRONCHIALE</h5>
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<tbody>
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<td width="504"><br /></td>
<td width="26"><br /></td>
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</tr>
</tbody></table>
<br />Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-82745612408730226892011-11-10T07:16:00.001-08:002011-11-10T07:17:12.047-08:00MENINGITIS<!--[if gte mso 9]><xml>
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<br />
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">ASUHAN KEPERAWATAN PADA PASIEN MENINGITIS</span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="tab-stops: 18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">I.<span style="mso-tab-count: 1;"> </span>LANDASAN<span style="mso-spacerun: yes;"> </span>TEORI</span></b><span lang="EN-GB"> .</span></div>
<div class="MsoNormal">
<br /></div>
<h2 style="margin-left: 18.0pt; tab-stops: 36.0pt;">
<span lang="EN-GB">A.<span style="mso-tab-count: 1;"> </span>PENGERTIAN </span></h2>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Miningitis adalah suatu reaksi
keradangan yang mengenai satu atau semua lapisan selaput yang menghubungkan
jaringan otak dan sumsum tulang belakang, yang menimbulkan eksudasi berupa pus
atau serosa, disebabkan oleh bakteri spesifik / non spesifik atau virus.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 36.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">B.<span style="mso-tab-count: 1;"> </span>ANATOMI<span style="mso-spacerun: yes;">
</span>&<span style="mso-spacerun: yes;"> </span>FISIOLOGI<span style="mso-spacerun: yes;"> </span>SELAPUT<span style="mso-spacerun: yes;">
</span>OTAK.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Selaput otak terdiri dari 3 lapisan
dari luar kedalam yaitu Durameter, Aranoid, Piameter.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Durameter terdiri dari lapisan yang
berfungsi kecuali didalam tulang tengkorak, dimana lapisan terluarnya melekat
pada tulang dan terdapat sinus venosus. Falx serebri adalah lapisan vertikal
durameter yang memisahkan kedua hemisfer serebri pada garis tengah. Tentorium
serebri adalah ruang horizontal dari Durameter yang memisahkan lobus
oksipitalis dari serebelum.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Araknoid merupakan membran lembut
yang bersatu ditempatnya dengan parameter, diantaranya terdapat ruang subarnoid
dimana terdapat arteri dan vena serebral dan dipenuhi oleh cairan serebrospinal.
Sisterna magna adalah bagian terbesar dari ruang subaranoid disebelah belakang
otak belakang, memenuhi celah diantara serebelum dan medulla oblongata.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Piamater merupakan membran halus yang
kaya akan pembuluh darah kecil yang mensuplai darah keotak dalam jumlah yang
banyak. Piameter adalah lapisan yang langsung melekat dengan permukaan otak dan
seluruh medula spinalis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Miningitis dapat disebabkan oleh
berbagai organisme yang bervariasi, tetapi ada tiga tipe utama yakni:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Infeksi bakteri, piogenik yang
disebabkan oleh bakteri pembentuk pus, terutama meningokokus, pneumokokus, dan
basil influenza.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Tuberkulosis, yang disebabkan
oleh basil tuberkel (Mycobacterium tuberculose).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo1; tab-stops: 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Infeksi virus, yang disebabkan
oleh agen-agen virus yang sangat bervariasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 36.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">C.<span style="mso-tab-count: 1;"> </span>ETIOLOGI<span style="mso-spacerun: yes;">
</span>&<span style="mso-spacerun: yes;"> </span>EPIDEMIOLOGI</span></b><span lang="EN-GB">.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Miningitis bakteri dapat disebabkan
oleh setiap agen bakteri yang bervariasi. Haemophilus Influenza (Tipe β), <i style="mso-bidi-font-style: normal;">Streptococcus pneumoniae, dan Naisseria
Miningitis </i><span style="mso-spacerun: yes;"> </span>(meningokokus)
bertanggung jawab terhadap meningitis pada 95 % anak-anak yang lebih tua dari
usia 2 bulan. Haemophilus influenzae merupakan organisme yang dominan pada usia
anak-anak 3 bulan sampai dengan 3 tahun, tetapi jarang pada bayi dibawah 3
bulan, yang terlindungi oleh substansi bakteri yang didapat secara pasif dan
pada anak-anak diatas 5 tahun yang mulai mendapat perlindungan ini.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Organisme lain adalah <i style="mso-bidi-font-style: normal;">Streptococus</i> <i style="mso-bidi-font-style: normal;">β hemolyticus, Staphylococcus aureus, dan Escherichia coli.</i>
Penyebab utama meningitis neonatus adalah organisme <i style="mso-bidi-font-style: normal;">Streptococcus </i><span style="mso-spacerun: yes;"> </span>β <i style="mso-bidi-font-style: normal;">hemolyticus dan Escherichia coli</i>.
Infeksi Escherichia coli jarang terjadi pada anak-anak usia setelah bayi (lebih
dari 1 tahun). Meningitis meningokokus (serebrospinal epidemik) terjadi pada
bentuk epidemik dan merupakan satu-satunya tipe yang ditularkan melalui infeksi
droplet dari sekresi nasofaring. Meskipun kondisi ini dapat berkembang pada
setiap usia, risiko infeksi meningokokus meningkat dengan seringnya kontak dan
oleh karena itu infeksi terutama terjadi pada anak-anak usia sekolah dan
adolesens.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Laki-laki lebih sering terkena
dibandingkan dengan perempuan terutama pada periode neonatal. Angka kesakitan
tertinggi seteleh timbulnya meningitis mengenai anak-anak pada usia antara
kelahiran sampai dengan empat tahun (dibawah lima tahun). Faktor maternal
seperti ketuban pecah dini dan infeksi ibu hamil selama trimester akhir
merupakan penyebab utama meningitis neonatal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Terjadinya defisiensi pada mekanisme imun
dan berkurangnya aktivitas leukosit dapat mempengaruhi insiden pada bayi baru
lahir, anak-anak dengan defisiensi imunoglobulin, dan anak-anak yang menerima
obat-obatan imunosupresif. Meningitis yang muncul sebagai perluasan dari
infeksi-infeksi bakteri yang bervariasi kemungkinan disebabkan kurangnya
resistensi terhadap berbagai organisme penyebab. Adanya kelainan SSP, prosedur
/ trauma bedah saraf, infeksi-infeksi primer dilain organ merupakan
faktor-faktor yang dihubungkan dengan mudahnya terkena penyakit ini. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: 54.0pt;">
<br /></div>
<h6>
<span lang="EN-GB">D.<span style="mso-tab-count: 1;"> </span>PATOFISIOLOGI</span></h6>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Rute infeksi yang paling sering
adalah penyebaran vaskuler dari fokus-fokus infeksi ketempat lain. Contohnya
organisme nasofaring menyerang pembuluh-pembuluh darah yang terdapat didaerah
tersebut dan memasuki aliran darah keserebral atau membentuk tromboemboli yang
melepaskan emboli sepsis kedalam aliran darah. Invasi oleh perluasan langsung
dari infeksi-infeksi disinus paranasal dan disinus mastoid jarang terjadi.
Organisme-organisme dapat masuk melalui implantasi langsung setelah luka yang
tertembus, fraktur tulang tengkorak yang memberikan sebuah lubang kedalam kulit
atau sinus, lumbal fungsi, prosedur pembedahan dan kelainan-kelainan anatomis
seperti shunt ventrikuler. Organisme-organisme yang terimplantasi menyebar
kedalam cairan serebrospinal oleh penyebaran infeksi sepanjang rongga
subarnoid.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify; text-indent: 27.0pt;">
<span lang="EN-GB">Proses infeksi yang terlihat adalah
inflamasi, eksudasi akumulasi leukosit dan tingkat kerusakan jaringan yang
bervariasi. Otak menjadi hiperemis, edema, dan seluruh permukaan otak tertutup
oleh lapisan eksudat purulen dengan bervariasi organisme.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoBodyTextIndent2" style="margin-left: 36.0pt; mso-list: l6 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB"><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">MANIFESTASI<span style="mso-spacerun: yes;"> </span>KLINIK.</span></b></div>
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<span lang="EN-GB">Neonatus<span style="mso-spacerun: yes;"> </span>:</span></div>
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<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Gejala tidak khas</span></div>
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<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Panas<span style="mso-spacerun: yes;"> </span>±</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level2 lfo2; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Anak tampak malas, lemah, tidak
mau minum, muntah dan kesadaran menurun.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level2 lfo2; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Ubun-ubun besar kadang-kadang
cembung.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level2 lfo2; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Pernafasan tidak teratur.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">Anak umur<span style="mso-spacerun: yes;"> </span>2
bulan<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>> 2 tahun<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; mso-list: l5 level2 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -27.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Gambaran klasik (-)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; mso-list: l5 level2 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -27.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Hanya panas, muntah, gelisah,
kejang berulang.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 81.0pt; mso-list: l5 level2 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -27.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Kadang-kadang “ high pitched
cry “.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">Anak umur<span style="mso-spacerun: yes;"> </span>>
2<span style="mso-spacerun: yes;"> </span>tahun<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level1 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Panas , menggigil, muntah,
nyeri kepala.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level1 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Kejang</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level1 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Gangguan kesadaran.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level1 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">♦<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Tanda-tanda rangsang meningeal
: kaku kuduk, tanda Brudzinski dan Kering.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">Gejala yang sering terlihat<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Keluhan penderita mula-mula
nyeri kepala yang menjalar ketengkuk dan punggung</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Kesadaran menurun</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Kaku kuduk, disebabkan
mengejangnya otot-otot ekstensor tengkuk ;</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Terdapat tanda kernig dan
Brundzinski yang positif.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<span lang="EN-GB">Tanda kernig yang positif adalah bila paha ditekuk<span style="mso-spacerun: yes;"> </span>90°<span style="mso-spacerun: yes;">
</span>keventral, tungkai dapat diluruskan pada sendi lutut.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoBodyTextIndent2" style="margin-left: 36.0pt; mso-list: l6 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB"><span style="mso-list: Ignore;">F.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">PERUMUSAN<span style="mso-spacerun: yes;"> </span>DIAGNOSTIK.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 32.25pt;">
<span lang="EN-GB">Diagnostik miningitis akut bakteri
tidak dapat dibuat berdasarkan gejala klinis. Diagnosis pasti hanya dapat
ditegakkan berdasarkan pemeriksaan cairan serebrospinal melalui lumbal pungsi.
Tekanan cairan diukur dan cairannya diambil untuk kultur, pewarnaan gram,
hitung jenis, serta menentukan kadar glukosa dan protein. Penemuan ini umumnya
diagnostik Kultur dan pewarnaan gram dibutuhkan untuk menentukan kuman
penyebab. Tekanan cairan serebrospinal biasanya meningkat, tetapi
interpretasinya seringkali sulit bila anak sedang menangis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Umumnya dijumpai
leukositosis dengan predominan leukosit PMN, tapi bisa sangat bervariasi. Warna
cairan biasanya opalesen sampai keruh, reaksi nonne dan pandy akan positif.
Kadar khlorida akan menurun tapi ini tidak selalu terjadi. Kadar glukosa
berkurang, umunya sesuai perbandingan lamanya dan beratnya infeksi. Hubungan
antara glukosa dalam cairan serebrospinal dengan glukosa darah sangat penting
dalam mengevaluasi kadar glukosa dalam cairan serebrospinal, oleh karena itu
sampel glukosa darah diambil kira-kira 30 menit sebelum lumbal fungsi. Konsentrasi
protein biasanya meningkat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Kultur darah dianjurkan pada
anak-anak yang dicurigai menderita meningitis. Dijumpai leukositosis,
pergeseran ke kiri, dan anemia megaloblastik.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<h3 style="margin-left: 36.0pt; mso-list: none; tab-stops: 36.0pt; text-indent: -18.0pt;">
<span lang="EN-GB">G.<span style="mso-tab-count: 1;"> </span>PERAWATAN.</span></h3>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB">- Pada waktu
kejang.</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Longgarkan
pakaian, bila perlu dibuka</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Hisap lendir.</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Kosongkan
lambung untuk menghindari muntah dan aspirasi</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Hindarkan
penderita dari rudapaksa (mis jatuh )</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB">- Bila penderita
tidak sadar lama.</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Beri makanan
melalui sonda</span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-indent: -9.0pt;">
<span lang="EN-GB">* Cegah dekubitus dan pneumonia ortostatik dengan merubah posisi penderita
sesering mungkin.</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Cegah
kekeringan kornea dengan boorwater / salep antibiotika</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB">- Pada
inkontinensia alvi lakukan lavement</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB">- Pemantauan
ketat.</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Tekanan Darah</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Pernafasan</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* nadi</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Produksi air
kemih</span></div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<span lang="EN-GB">* Faal
hemostasis untuk mengetahui secara dini ada DIC</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB">- Penanganan
penyulit.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-GB">- Fisiotherapi
dan rehabilitasi.</span></div>
<div class="MsoNormal">
<br /></div>
<h3 style="margin-left: 36.0pt; mso-list: none; tab-stops: 36.0pt; text-indent: -18.0pt;">
<span lang="EN-GB">H.<span style="mso-tab-count: 1;"> </span>PENATALAKSANAAN</span></h3>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">Farmakologis<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-GB">= Obat anti infeksi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; text-align: justify;">
<span lang="EN-GB">* Miningitis tuberkuosa :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 63.0pt; text-align: justify; text-indent: -9.0pt;">
<span lang="EN-GB">- Isoniazid 10 –20 mg/kg/24 jam oral,
2 x sehari maksimal 500 mg, selama 1½ tahun.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: 27.0pt;">
<span lang="EN-GB">- Rifampisin 10 –15 mg/kg/24 jam
oral, 1 x sehari selama 1 tahun.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: 27.0pt;">
<span lang="EN-GB">- Streptomisin sulfat 20 – 40
mg/kg/24 jam (IM) 1-2 x sehari, selama 3 bulan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; text-align: justify;">
<span lang="EN-GB">* Miningitis bakterial, umur < - 2 bulan:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">- Sefalosporin Generasi ke 3</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<span lang="EN-GB">- Ampisilina 150 – 200 mg (400mg)/kg/24 jam IV, 4-6 x
sehari, dan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<span lang="EN-GB">- Kloramfenikol 50 mg/kg BB/24 jam IV 4 x / hari.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; text-align: justify;">
<span lang="EN-GB">* Miningitis bakterial umur > bulan:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: 27.0pt;">
<span lang="EN-GB">- Ampisilina 150 – 200 mg (400mg)/
kg/24 jam IV, 4-6 sehari .</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: 27.0pt;">
<span lang="EN-GB">- Kloramfenikol 100 mg/kg/24 jam IV,
4 x sehari atau</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify; text-indent: 27.0pt;">
<span lang="EN-GB">- Sefalosporin Generasi ke 3.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify;">
<span lang="EN-GB">= Pengobatan Simtomatis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">* Diazepam IV; 0,2 – 0,5 mg / kg/dosis,
atau rektal : 0,4 – 0,6 mg/kg/ dosis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<span lang="EN-GB">Kemudian dilanjutkan dengan:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<span lang="EN-GB">- Fenitoin 5 mg/kg/24 jam, 3 x sehari
atau</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<span lang="EN-GB">- Fenobarbital 5 – 7 mg /kg/24 jam, 3 kali sehari.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">* Turunkan panas:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<span lang="EN-GB">- Antipiretik: parasetamol/salisilat 10
mg/kg/dosis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<span lang="EN-GB">- Kompres air PAM / es</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify;">
<span lang="EN-GB">= Pengobatan Suportif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">* Cairan intravena</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">* Zat asam.</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<br /></div>
<h2 style="margin-left: 36.0pt; tab-stops: 36.0pt; text-indent: -18.0pt;">
<span lang="EN-GB">I.<span style="mso-tab-count: 1;"> </span>PROGNOSA<span style="mso-spacerun: yes;"> </span></span></h2>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Usia anak, kecepatan
diagnosa setelah timbulnya gejala dan terapi yang adekwat penting dalam
prognosa meningitis bakteri. Mortalitas miningitis neonatus kira-kira 50 %
meskipun gejala yang timbul terlambat, sedangkan meningitis streptokokus β
hemolitikus menimbulkan 15 – 20 % kasus fatal. Bila penyebabnya hemofilus
influensya dan miningitis meningokokus, angka mortalitas 5 – 10 % sedangkan
meningitis pneumokokus pada bayi dan anak-anak kira-kira 20 %.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Gejala sisa
miningitis bacteri paling sering terjadi pada anak-anak usia 2 tahun pertama
dan sangat sedikit pada anak-anak dengan miningitis meningokokus. Gejala sisa
pada bayi terutama disebabkan oleh hidrosefalus komunikasi dan efek-efek yang
lebih besar berupa cerebritis pada otak yang belum matang. Pada anak-anak yang
lebih besar gajala sisa dihubungkan dengan proses peradangan itu sendiri atau
akibat dari vaskulitis (radang pembuluh darah) yang menyertai penyakit ini.
Evaluasi saraf N VIII penting atau sekurang-kurangnya follow up 6 bulan untuk
mengkaji kemungkinan hilangnya pendengaran.</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<br /></div>
<h4>
<span lang="EN-GB">Asuhan<span style="mso-spacerun: yes;">
</span>Keperawatan<span style="mso-spacerun: yes;"> </span>Miningitis</span></h4>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">Pengkajian<span style="mso-spacerun: yes;"> </span>Keperawatan<span style="mso-spacerun: yes;">
</span>:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 0cm; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Pengkajian keperawatan meningitis
tergantung pada tingkat yang luas pada usia anak-anak. Gambaran klinis juga
dipengaruhi oleh beberapa tingkat tipe organisme dan efektivitas tetapi
terhadap penyakit yang mendahuluinya. Berikut ini pengkajian keperawatan
berdasarkan golongan usia tumbuh kembang anak.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l1 level1 lfo5; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB">Riwayat Kesehatan Masa Lalu.</span></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 18.0pt;">
<span lang="EN-GB">Mencakup
beberapa pertanyaan sebagai berikut<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 45.0pt;">
<span lang="EN-GB">- Apakah
pernah menderita inpeksi saluran pernafasan akut (ISPA).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">- Apakah pernah mengalami prosedur
neurosurgital</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">- Apakah pernah menderita trauma yang
mencederai kepala</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">- Adakah kelainan bawaan (spina bifida)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">- Bagaimana riwayat kesehatan ibu
selama hamil</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">- Bagaimana riwayat kesehatan keluarga</span></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 45.0pt;">
<span lang="EN-GB">-
Bagaimana riwayat imunisasi, dll.</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<br /></div>
<div class="MsoHeading7">
<span lang="EN-GB">Neonatus</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Meningitis pada bayi baru lahir dan
bayi prematur benar-benar sulit untuk didiagnosa. Manifestasinya samar-samar
dan tidak spesifik. Bayi-bayi ini biasanya tampak sehat ketika lahir, tetapi
dalam beberapa hari kemudian tampak mulai melemah. Mereka tidak mau makan,
kemampuan mengisap buruk, bisa muntah atau diare. Tonus otot melemah
(hipotonus), kurang gerak, tangisan melemah. Tanda-tanda lain yang nonspesifik
yang dapat muncul meliputi hipotermia atau demam (bergantung pada kematangan
bayi), ikterik, mudah terangsang, mengantuk, kejang, napas tidak teratur,
apnea, sianosis, dan berat badan menurun. Ubun-ubun menonjol, tegang dapat
muncul atau tidak sampai akhir perjalanan penyakit. Bila tidak diobati kondisi
anak cenderung menurun hingga kolaps sistem kardiovaskuler, kejang, dan apnea.</span></div>
<div class="MsoHeading7">
<span lang="EN-GB">Bayi dan Balita</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Gambaran klasik meningitis jarang
terlihat pada anak-anak usia 3 bulan – 2 tahun. Penyakit ini ditandai secara
khas dengan demam, tidak nafsu makan muntah, peka terhadap rangsangan, serangan
kejang berulang, yang disertai tangisan merintih. Ubun-ubun besar yang menonjol
merupakan penemuan yang paling bermakna dan kaku kuduk dapat muncul/tidak.
Tanda-tanda Brudzinski dan Kernig biasanya tidak membantu diagnostik karena
sulit untuk menemukannya dan mengevaluasinya pada anak-anak usia ini. </span></div>
<div class="MsoHeading7" style="tab-stops: 36.0pt;">
<span lang="EN-GB">Anak dan
Adolesens</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-GB">Timbulnya penyakit mungkin tiba-tiba,
demam, sakit kepala, muntah yang disertai /dengan cepat diikuti oleh perubahan
sensoris. Sering kali gejala awal nya berupa kejang yang berulang karena
penyakitnya memburuk. Anak jadi mudah terangsang, gelisah, dan dapat berkembang
menjadi fotofobia, delirium, halusinasi, kelakuan yang agresif/maniak,
mengantuk, stupor, bahkan koma. Kadang-kadang datangnya gejala perlahan-lahan,
sering kali didahului oleh gejala-gejala gastrointestinal selama beberapa
hari.Kadang-kadang infeksi sebelumnya yang telah diobati menutupi atau
memperlambat tanda-tanda meningitis.Anak menolak fleksi dari leher dan karena
penyakit bertambah buruk, leher menjadi kaku kuduk sampai kepalanya tertarik
kebelakang / hiperekstensi (opitotonus). Tanda Kernig positif, Brudzinski
positif. Respons-respons refleks bervariasi, meskipun mereka memperlihatkan
hiperaktivitas. Kulit mungkin dingin dan sianotik dengan perfusi perifer yang
buruk.</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">PENGKAJIAN MININGITIS</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify; text-indent: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 0cm; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">1. Riwayat:<span style="mso-tab-count: 1;"> </span>Mengalami infeksi
saluran pernapasan atau infeksi telinga, kontak dengan pasien rinitis.
Pneumonia dan otitis media seringkali mendahului pneumokokus dan hemofilus
miningitis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 45.0pt; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">2. Gejala
subjektif:<span style="mso-tab-count: 1;"> </span>Sakit kepala
yang hebat, nyeri otot, kaku kuduk, sakit punggung, dingin, ekspresi rasa
takut. Tidak enak badan dan mudah terangsang.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 45.0pt; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">3. Suhu tubuh:<span style="mso-tab-count: 1;"> </span>38– 41° C, dimulai pada
fase sistemik, kemerahan, panas, kulit kering,berkeringat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 0cm; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">4. Tanda Vital:<span style="mso-tab-count: 1;"> </span>Nadi lambat sehingga
intra kranial meningkat dan Tekanan Darah meningkat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 45.0pt; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">5. Tingkat
kesadaran:<span style="mso-tab-count: 1;"> </span>Mula-mula sadar
kemudian delirium dan akhirnya Koma.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 45.0pt; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">6. Persarafan:<span style="mso-tab-count: 1;"> </span>Perubahan refleks.
Tidak adanya refleks dinding abdomen, tidak adanya refleks kremasterik pada
laki-laki, gangguan refleks tendon. Kaku kuduk. Tanda Brudzinski positif, tanda
Kernig positif. Ubun-ubun besar menonjol (bayi).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 45.0pt; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">7. Cairan &
Elektrolit:<span style="mso-tab-count: 1;"> </span>Turgor kulit
jelek, berkurangnya output urin. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 45.0pt; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">8. Muskuloskeletal
Meningokoksemia kronik : bengkak dan nyeri pada sendi-sendi besar (khususnya
lutut dan pergelangan kaki).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 0cm; text-align: justify; text-indent: -144.0pt;">
<span lang="EN-GB">9. Kulit:
Meningokoksemia:Ptekia dan lesipurpura yang didahului oleh ruam. Pada penyakit
yang berat dapat ditemukan ekimosis yang besar pada wajah dan ekstremitas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; tab-stops: 45.0pt; text-align: justify; text-indent: -144.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">Diagnosa yang muncul<span style="mso-spacerun: yes;"> </span>:</span></i></b></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB"><span style="mso-spacerun: yes;"> </span>Infeksi sehubungan dengan adanya kuman
patogen pada cairan serebrospinal dan sekret saluran pernapasan.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Perubahan perfusi jaringan otak
sehubungan dengan peradangan dan edema pada otak dan selaput otak.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Ketidak efektipan pola pernapasan sehubungan
dengan perubahan tingkat kesadaran.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Gangguan perfusi jaringan perifer
sehubungan dengan infeksi meningokokus.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Ketidak efektifan bersihan jalan nafas
sehubungan dengan perubahan tingkat kesadaran.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Nyeri sehubungan dengan peradangan pada
selaput otak dan jaringan otak.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Hipertemia sehubungan dengan infeksi.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Potensial defisit cairan sehubungan
dengan muntah dan demam.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Potensial berlebihannya volume cairan
sehubungan dengan sekresi ADH berlebihan.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Takut sehubungan dengan parahnya
kondisi.</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo7; tab-stops: 36.0pt; text-align: justify;"><span lang="EN-GB">Kurangnya perawatan diri sendiri
sehubungan dengan perubahan susunan saraf pusat.</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">Diagnosa dan Perencanaan
Keperawatan<span style="mso-spacerun: yes;"> </span>yang dibahas<span style="mso-spacerun: yes;"> </span>:</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 45.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">1. Infeksi sehubungan
dengan adanya kuman patogen pada cairan serebrospinal dan sekret saluran
pernapasan.</span></i></b><i style="mso-bidi-font-style: normal;"><span lang="EN-GB"><span style="mso-spacerun: yes;"> </span></span></i></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 45.0pt;">
<span lang="EN-GB">Data
penunjang :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Laboratorium positif adanya
kuman penyebab</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Adanya eksudat saluran napas
atas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Riwayat infeksi saluran napas
atau terpapar baru-baru ini dengan pasien rinitis atau meningitis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Riwayat infeksi virus sistemik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Riwayat memakai obat-obatan
imunosupresif</span></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 45.0pt;">
<span lang="EN-GB">Tujuan<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Pasien bebas dari infeksi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Komplikasi-komplikasi
meningitis bakterial dapat dicegah dengan terapi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; tab-stops: 45.0pt; text-align: justify;">
<span lang="EN-GB">dini dan efektif</span></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 45.0pt;">
<span lang="EN-GB">Intervensi<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level3 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB">Gunakan isolasi pernapasan selama 24 jam setelah permulaan terapi
antibiotoka untuk meningitis bakterial</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Gunakan pelindung sekret selama
dirawat karena meningitis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Anjurkan orang-orang yang
kontak dengan pasien diperiksa dan diobati</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Bantu kumpulkan CSS. Catat
jumlah dan karakterisik CSS. Beri antibiotika sesegera mungkin sesuai instrusi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 45.0pt;">
<span lang="EN-GB">Rasionalisasi<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level3 lfo4; tab-stops: 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB">Terapi dini antibiotika penting untuk mencegah komplikasi-komplikasi
meningitis bakterial</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Setiap jam itu penting</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Mencegah penularan selama waktu
penularan yang tinggi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Mencegah penularan kuman dan
mengurangi resiko infeksi dari orang-orang yang kontak dengan pasien</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Sebagai diagnosa laboratorium
untuk kuman penyebab dan mencegah penularan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 45.0pt;">
<span lang="EN-GB">Evaluasi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo6; tab-stops: 54.0pt; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Pasien terbebas dari infeksi
dan komplikasi meningitis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Laboratorium CSS :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; tab-stops: 45.0pt;">
<span lang="EN-GB">< 30 sel/mm, glukosa dan protein normal, tekanan normal, dan
kultur</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; tab-stops: 45.0pt;">
<span lang="EN-GB">negatif.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Refleks pupil normal, kaku
kuduk negatif, refleks abdominal negatif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Kesadaran penuh, orentasi baik,
dan memori baik.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo6; tab-stops: 45.0pt list 54.0pt; text-indent: -18.0pt;">
<span lang="EN-GB"><span style="mso-list: Ignore;">2.</span></span><span lang="EN-GB">Infeksi tidak menular keorang-orang yang pernah kontak dengan pasien</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 99.0pt; mso-list: l2 level2 lfo6; tab-stops: 45.0pt list 72.0pt; text-indent: -45.0pt;">
<span lang="EN-GB" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-GB">Perawat/ tenaga medis rumah sakit dan kontak pasien bebas dari
infeksi</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 18.0pt; text-align: justify; text-indent: -18.0pt;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">2.<span style="mso-spacerun: yes;"> </span>Perubahan perfusi jaringan otak sehubungan
dengan peradangan dan edema pada otak dan otak meninges.</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; tab-stops: 45.0pt; text-align: justify;">
<br /></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 18.0pt;">
<span lang="EN-GB">Data
penunjang<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Malaise, pusing, nausea,
muntah, iritabilitas, kejang, kesadaran menurun bingung, delirium, koma.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Perubahan refleks-refleks,
tanda-tanda neurologik, fokal pada meningitis, tanda-tanda peningkatan tekanan
intrakranial ( bradikardi, tekanan darah meningkat ), nyeri kepala hebat. </span></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 18.0pt;">
<span lang="EN-GB">Tujuan<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Pasien dapat memperlihatkan
perfusi jaringan memadai.</span></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 45.0pt;">
<span lang="EN-GB">Intervensi<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Monitor pasien dengan ketat
terutama setelah pungsi lumbal. Anjurkan pasien berbaring minimal 4<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;"> </span>6
jam setelah pungsi lumbal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Monitor tanda-tanda peningkatan
tekanan inrtakranial selama perjalanan penyakit (nadi lambat, tensi meningkat,
kesadaran menurun, napas aritmik, refleks pupil menurun, kelemahan).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Monitor tanda-tanda vital dan
neurologik tiap 5<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;"> </span>30 menit. Mengenai tekanan intrakranial catat
laporkan segera perubahan-perubahannya kedokter.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Hindari posisi tungkai ditekuk
atau gerakan-gerakan pasien, anjurkan untuk bedrest.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Tinggikan sedikit kepala pasien
dengan hati-hati cegah gerakan yang tiba-tiba dan tidak perlu dari kepala dan
leher hindari fleksi leher.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Bantu seluruh aktivitas dan
gerakan-gerakan pasien. Beri petunjuk untuk BAB (jangan enema). Anjurkan pasien
untuk menghembuskan napas dalam bila miring dan bergerak ditempat tidur. Cegah
posisi fleksi pada dan lutut.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Waktu prosedur-prosedur
perawatan disesuaikan / diatur tepat waktu dengan preode relaksasi / sedasi ;
hindari rangsangan lingkungan yang tidak perlu.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Beri penjelasan kepada pasien
yang bingung ; artikan / jelaskan lingkungan kepasien dan reorientasikan pasien
yang bingung.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Evaluasi selama masa
penyembuhan terhadap gangguan motorik, sensorik dan intelektual.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Beri zat hipertonik / steroid
sesuai dengan instruksi.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 18.0pt; text-align: justify;">
<span lang="EN-GB">Rasionalisasi<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk mencegah nyeri kepala
yang menyertai perubahan tekanan intrakranial</span></div>
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<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk mendeteksi tanda-tanda
syok, yang harus dilaporkan kedokter untuk intervensi dini.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Perubahan-perubahan ini
menandakan ada perubahan tekanan intrakranial dan penting untuk intervensi
dini.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk mencegah peningkatan
tekanan intrakranial.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk mengurangi tekanan
intrakranial.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk mencegah keregangan otot
yang dapat menimbulkan peningkatan tekanan intrakranial.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk mencegah eksitasi yang
merangsang otak yang sudah iritasi dan dapat menimbulkan kejang.</span></div>
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<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk mengurangi disorientasi
dan untuk klarifikasi persepsi sensoris yang terganggu.</span></div>
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<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk merujuk ke rehabilitasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Untuk menurunkan tekanan
intrakranial.</span></div>
<div class="MsoBodyTextIndent3" style="tab-stops: 18.0pt;">
<span lang="EN-GB">Evaluasi<span style="mso-spacerun: yes;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 0cm; text-align: justify;">
<span lang="EN-GB">Perfusi jaringan dan oksigenasi baik </span></div>
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<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Tanda-tanda vital dalam batas
normal</span></div>
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<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Syok dapat dihindari.</span></div>
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<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Purpura negatif, ptekia
negatif.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Pasien sadar, disorentasi
negatif, konsentrasi baik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: 45.0pt list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span lang="EN-GB" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-GB">Afek sesuai dengan rangsangan
lingkungan. </span></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-72105892302170476092011-11-10T07:14:00.001-08:002011-11-10T07:18:55.193-08:00ASKEP UROLITIASIS<br />
<div class="WordSection1">
<div class="MsoSubtitle">
KONSEP DASAR UROLITHIASIS</div>
<div class="MsoSubtitle">
<br /></div>
<div class="MsoSubtitle">
<span style="text-transform: none;">Pengertian</span></div>
<div class="MsoNormal">
Urolithiasis adalah suatu keadaan terjadinya penumpukan
oksalat, calculi (batu ginjal) pada ureter atau pada daerah ginjal.
Urolithiasis terjadi bila batu ada di dalam saluran perkemihan. Batu itu
sendiri disebut calculi. Pembentukan batu mulai dengan kristal yang
terperangkap di suatu tempat sepanjang saluran perkemihan yang tumbuh sebagai
pencetus larutan urin. Calculi bervariasi dalam ukuran dan dari fokus
mikroskopik sampai beberapa centimeter dalam diameter cukup besar untuk masuk
dalam velvis ginjal. Gejala rasa sakit yang berlebihan pada pinggang, nausea,
muntah, demam, hematuria. Urine berwarna keruh seperti teh atau merah.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Faktor – faktor yang mempengaruhi pembentukan batu</b></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l10 level1 lfo5; tab-stops: list 21.85pt; text-indent: -21.85pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Faktor Endogen</div>
<div class="MsoNormal" style="margin-left: 22.5pt;">
Faktor genetik, familial, pada
hypersistinuria, hiperkalsiuria dan hiperoksalouria.</div>
<div class="MsoNormal" style="margin-left: 22.5pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l10 level1 lfo5; tab-stops: list 21.85pt; text-indent: -21.85pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Faktor Eksogen</div>
<div class="MsoNormal" style="margin-left: 22.5pt;">
Faktor lingkungan, pekerjaan,
makanan, infeksi dan kejenuhan mineral dalam air minum.</div>
<div class="MsoNormal" style="margin-left: 22.5pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l10 level1 lfo5; tab-stops: list 21.85pt; text-indent: -21.85pt;">
c.<span style="font: 7pt "Times New Roman";">
</span>Faktor lain</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
a)<span style="font: 7pt "Times New Roman";">
</span>Infeksi</div>
<div class="MsoBodyTextIndent" style="margin-left: 45.0pt;">
Infeksi Saluran Kencing
(ISK) dapat menyebabkan nekrosis jaringan ginjal dan akan menjadi inti
pembentukan Batu Saluran Kencing (BSK) Infeksi bakteri akan memecah ureum dan
membentuk amonium yang akan mengubah pH Urine menjadi alkali.</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
b)<span style="font: 7pt "Times New Roman";">
</span>Stasis dan Obstruksi Urine</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
Adanya obstruksi dan stasis urine
akan mempermudah Infeksi Saluran Kencing.</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
c)<span style="font: 7pt "Times New Roman";">
</span>Jenis Kelamin</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
Lebih banyak terjadi pada
laki-laki dibanding wanita dengan perbandingan 3 : 1</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
d)<span style="font: 7pt "Times New Roman";">
</span>Ras</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
Batu Saluran Kencing lebih banyak
ditemukan di Afrika dan Asia.</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
e)<span style="font: 7pt "Times New Roman";">
</span>Keturunan</div>
<div class="MsoBodyTextIndent2">
Anggota keluarga Batu Saluran Kencing lebih banyak
mempunyai kesempatan</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
f)<span style="font: 7pt "Times New Roman";">
</span>Air Minum</div>
<div class="MsoBodyTextIndent3">
Memperbanyak diuresis dengan cara banyak minum air
akan mengurangi kemungkinan terbentuknya batu, sedangkan kurang minum
menyebabkan kadar semua substansi dalam urine meningkat.</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
g)<span style="font: 7pt "Times New Roman";">
</span>Pekerjaan</div>
<div class="MsoBodyTextIndent2">
Pekerja keras yang banyak bergerak mengurangi
kemungkinan terbentuknya batu dari pada pekerja yang lebih banyak duduk.</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
h)<span style="font: 7pt "Times New Roman";">
</span>Suhu</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
Tempat yang bersuhu panas
menyebabkan banyak mengeluarkan keringan.</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l10 level2 lfo5; tab-stops: list 43.65pt; text-indent: -21.8pt;">
i)<span style="font: 7pt "Times New Roman";">
</span>Makanan</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
Masyarakat yang banyak mengkonsumsi
protein hewani angka morbiditas Batu Saluran Kencing berkurang. Penduduk yang
vegetarian yang kurang makan putih telur lebih sering menderita Batu Saluran
Kencing (buli-buli dan Urethra).</div>
<div class="MsoNormal" style="margin-left: 45.0pt;">
<br /></div>
<div class="MsoNormal">
<b>Patogenesis</b></div>
<div class="MsoNormal">
Sebagian besar Batu Saluran Kencing adalah idiopatik,
bersifat simptomatik ataupun asimptomatik.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Teori Terbentuknya Batu</b></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l7 level1 lfo6; tab-stops: list 21.85pt; text-indent: -21.85pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Teori Intimatriks</div>
<div class="MsoNormal" style="margin-left: 22.5pt;">
Terbentuknya Batu Saluran Kencing
memerlukan adanya substansi organik Sebagai inti. Substansi ini terdiri dari
mukopolisakarida dan mukoprotein A yang mempermudah kristalisasi dan agregasi
substansi pembentukan batu.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l7 level1 lfo6; tab-stops: list 21.85pt; text-indent: -21.85pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Teori Supersaturasi</div>
<div class="MsoNormal" style="margin-left: 22.5pt;">
Terjadi kejenuhan substansi
pembentuk batu dalam urine seperti sistin, santin, asam urat, kalsium oksalat
akan mempermudah terbentuknya batu.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l7 level1 lfo6; tab-stops: list 21.85pt; text-indent: -21.85pt;">
c.<span style="font: 7pt "Times New Roman";">
</span>Teori Presipitasi-Kristalisasi</div>
<div class="MsoNormal" style="margin-left: 22.5pt;">
Perubahan pH urine akan
mempengaruhi solubilitas substansi dalam urine. Urine yang bersifat asam akan
mengendap sistin, santin dan garam urat, urine alkali akan mengendap
garam-garam fosfat.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l7 level1 lfo6; tab-stops: list 21.85pt; text-indent: -21.85pt;">
d.<span style="font: 7pt "Times New Roman";">
</span>Teori Berkurangnya Faktor Penghambat</div>
<div class="MsoNormal" style="margin-left: 22.5pt;">
Berkurangnya Faktor Penghambat
seperti peptid fosfat, pirofosfat, polifosfat, sitrat magnesium, asam
mukopolisakarida akan mempermudah terbentuknya Batu Saluran Kencing.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>PENGKAJIAN DATA DASAR</b></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l0 level1 lfo10; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<b>1.<span style="font: 7pt "Times New Roman";">
</span></b><b>Riwayat atau adanya faktor resiko</b></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l0 level2 lfo10; tab-stops: list 43.65pt; text-indent: -21.8pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Perubahan metabolik atau diet</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l0 level2 lfo10; tab-stops: list 43.65pt; text-indent: -21.8pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Imobilitas lama</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l0 level2 lfo10; tab-stops: list 43.65pt; text-indent: -21.8pt;">
c.<span style="font: 7pt "Times New Roman";">
</span>Masukan cairan tak adekuat</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l0 level2 lfo10; tab-stops: list 43.65pt; text-indent: -21.8pt;">
d.<span style="font: 7pt "Times New Roman";">
</span>Riwayat batu atau Infeksi Saluran Kencing sebelumnya</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l0 level2 lfo10; tab-stops: list 43.65pt; text-indent: -21.8pt;">
e.<span style="font: 7pt "Times New Roman";">
</span>Riwayat keluarga dengan pembentukan batu</div>
<div class="MsoNormal" style="margin-left: 21.85pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l0 level1 lfo10; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<b>2.<span style="font: 7pt "Times New Roman";">
</span></b><b>Pemeriksaan fisik berdasarka pada survei umum
dapat menunjukkan :</b></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l0 level2 lfo10; tab-stops: list 43.65pt; text-indent: -21.8pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Nyeri. Batu dalam pelvis ginjal menyebabkan nyeri pekak
dan konstan. Batu ureteral menyebabkan nyeri jenis kolik berat dan hilang
timbul yang berkurang setelah batu lewat.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l0 level2 lfo10; tab-stops: list 43.65pt; text-indent: -21.8pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Mual dan muntah serta kemungkinan diare</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l0 level2 lfo10; tab-stops: list 43.65pt; text-indent: -21.8pt;">
c.<span style="font: 7pt "Times New Roman";">
</span>Perubahan warna urine atau pola berkemih, Sebagai
contoh, urine keruh dan bau menyengat bila infeksi terjadi, dorongan berkemih
dengan nyeri dan penurunan haluaran urine bila masukan cairan tak adekuat atau
bila terdapat obstruksi saluran perkemihan dan hematuri bila terdapat kerusakan
jaringan ginjal</div>
<div class="MsoNormal" style="margin-left: 21.85pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l0 level1 lfo10; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<b>3.<span style="font: 7pt "Times New Roman";">
</span></b><b>Pemeriksaan Diagnostik</b></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l8 level1 lfo7; tab-stops: list 43.65pt; text-indent: -21.8pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Urinalisa : warna : normal kekuning-kuningan, abnormal
merah menunjukkan hematuri (kemungkinan obstruksi urine, kalkulus renalis,
tumor,kegagalan ginjal). pH : normal 4,6 – 6,8 (rata-rata 6,0), asam
(meningkatkan sistin dan batu asam urat), alkali (meningkatkan magnesium,
fosfat amonium, atau batu kalsium fosfat), Urine 24 jam : Kreatinin, asam urat,
kalsium, fosfat, oksalat, atau sistin mungkin meningkat), kultur urine
menunjukkan Infeksi Saluran Kencing , BUN hasil normal 5 – 20 mg/dl tujuan
untuk memperlihatkan kemampuan ginjal untuk mengekskresi sisa yang bemitrogen.
BUN menjelaskan secara kasar perkiraan Glomerular Filtration Rate. BUN dapat
dipengaruhi oleh diet tinggi protein, darah dalam saluran pencernaan status
katabolik (cedera, infeksi). Kreatinin serum hasil normal laki-laki 0,85 sampai
15mg/dl perempuan 0,70 sampai 1,25 mg/dl tujuannya untuk memperlihatkan
kemampuan ginjal untuk mengekskresi sisa yang bemitrogen. Abnormal (tinggi pada
serum/rendah pada urine) sekunder terhadap tingginya batu obstruktif pada
ginjal menyebabkan iskemia/nekrosis.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l8 level1 lfo7; tab-stops: list 43.65pt; text-indent: -21.8pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Darah lengkap : Hb, Ht, abnormal bila pasien dehidrasi
berat atau polisitemia.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l8 level1 lfo7; tab-stops: list 43.65pt; text-indent: -21.8pt;">
c.<span style="font: 7pt "Times New Roman";">
</span>Hormon Paratyroid mungkin meningkat bila ada gagal
ginjal (PTH merangsang reabsorbsi kalsium dari tulang, meningkatkan sirkulasi
serum dan kalsium urine.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l8 level1 lfo7; tab-stops: list 43.65pt; text-indent: -21.8pt;">
d.<span style="font: 7pt "Times New Roman";">
</span>Foto Rontgen : menunjukkan adanya calculi atau
perubahan anatomik pada area ginjal dan sepanjang uriter.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l8 level1 lfo7; tab-stops: list 43.65pt; text-indent: -21.8pt;">
e.<span style="font: 7pt "Times New Roman";">
</span>IVP : memberikan konfirmasi cepat urolithiasis seperti
penyebab nyeri abdominal atau panggul. Menunjukkan abnormalitas pada struktur
anatomik (distensi ureter).</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l8 level1 lfo7; tab-stops: list 43.65pt; text-indent: -21.8pt;">
f.<span style="font: 7pt "Times New Roman";">
</span>Sistoureteroskopi : visualisasi kandung kemih dan
ureter dapat menunjukkan batu atau efek ebstruksi.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l8 level1 lfo7; tab-stops: list 43.65pt; text-indent: -21.8pt;">
g.<span style="font: 7pt "Times New Roman";">
</span>USG Ginjal : untuk menentukan perubahan obstruksi dan
lokasi batu.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Penatalaksanaan</b></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l9 level1 lfo8; tab-stops: list 21.85pt; text-indent: -21.85pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Menghilangkan Obstruksi</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l9 level1 lfo8; tab-stops: list 21.85pt; text-indent: -21.85pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Mengobati Infeksi</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l9 level1 lfo8; tab-stops: list 21.85pt; text-indent: -21.85pt;">
c.<span style="font: 7pt "Times New Roman";">
</span>Menghilangkan rasa nyeri</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l9 level1 lfo8; tab-stops: list 21.85pt; text-indent: -21.85pt;">
d.<span style="font: 7pt "Times New Roman";">
</span>Mencegah terjadinya gagal ginjal dan mengurangi
kemungkinan terjadinya rekurensi.</div>
<div class="MsoNormal">
<b>Komplikasi</b></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l6 level1 lfo9; tab-stops: list 21.85pt; text-indent: -21.85pt;">
a.<span style="font: 7pt "Times New Roman";">
</span>Obstruksi Ginjal</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l6 level1 lfo9; tab-stops: list 21.85pt; text-indent: -21.85pt;">
b.<span style="font: 7pt "Times New Roman";">
</span>Perdarahan</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l6 level1 lfo9; tab-stops: list 21.85pt; text-indent: -21.85pt;">
c.<span style="font: 7pt "Times New Roman";">
</span>Infeksi</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l6 level1 lfo9; tab-stops: list 21.85pt; text-indent: -21.85pt;">
d.<span style="font: 7pt "Times New Roman";">
</span>Hidronefrosis</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Diagnosa Keperawatan yang mungkin muncul</b></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l6 level2 lfo9; tab-stops: list 21.85pt; text-indent: -21.85pt;">
1.<span style="font: 7pt "Times New Roman";">
</span>Gangguan rasa nyaman (nyeri pada daerah pinggang)
berhubungan dengan cedera jaringan sekunder terhadap adanya batu pada ureter
atau pada ginjal</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l6 level2 lfo9; tab-stops: list 21.85pt; text-indent: -21.85pt;">
2.<span style="font: 7pt "Times New Roman";">
</span>Gangguan perfusi jaringan berhubungan dengan adanya
obstruksi (calculi) pada renal atau pada uretra.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l6 level2 lfo9; tab-stops: list 21.85pt; text-indent: -21.85pt;">
3.<span style="font: 7pt "Times New Roman";">
</span>Kecemasan berhubungan dengan kehilangan status
kesehatan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l6 level2 lfo9; tab-stops: list 21.85pt; text-indent: -21.85pt;">
4.<span style="font: 7pt "Times New Roman";">
</span>Kurangnya pengetahuan tentang sifat penyakit, tujuan tindakan
yang diprogramkan dan pemeriksaan diagnostik berhubungan dengan kurangnya
informasi.</div>
<div class="MsoNormal">
<br /></div>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<br />
<div class="WordSection2">
<h1 style="mso-list: l3 level3 lfo13; tab-stops: list 36.0pt 108.0pt;">
<span style="text-transform: none;">II.<span style="font: 7pt "Times New Roman";"> </span></span><span style="text-transform: none;">PERENCANAAN TINDAKAN PERAWATAN</span></h1>
<div class="MsoTitle">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 5.4pt; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-table-layout-alt: fixed;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 2.0cm;" width="76"><div class="MsoTitle">
TGL</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" width="189"><div class="MsoTitle" style="margin-right: -4.95pt;">
Diagnosa Keperawatan/Data
Penunjang</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" width="189"><div class="MsoTitle">
TUJUAN/KRITERIA</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" width="302"><div class="MsoTitle">
RENCANA TINDAKAN</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" width="302"><div class="MsoTitle">
rasional</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div class="MsoTitle" style="margin-right: -4.05pt;">
NAMA PERAWAT / MAHASISWA</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 2.0cm;" valign="top" width="76"><div class="MsoNormal">
1 April 2002</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal">
Gangguan rasa nyaman (nyeri pada daerah pinggang)
berhubungan dengan cedera jaringan sekunder terhadap adanya batu pada ureter
atau pada ginjal</div>
<div class="MsoNormal">
Data Penunjang :</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kolik yang berlebihan</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Lemes, mual, muntah, keringat dingin</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien gelisah</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal">
Tujuan :</div>
<div class="MsoNormal">
Rasa sakit dapat diatasi/hilang</div>
<div class="MsoNormal">
Kriteria :</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kolik berkurang/hilang</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien tidak mengeluh nyeri</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Dapat beristirahat dengan tenang</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302"><div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kaji intensitas, lokasi dan tempat/area serta
penjalaran dari nyeri. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Observasi adanya abdominal pain</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kaji adanya keringat dingin, tidak dapat istirahat
dan ekspresi wajah.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Jelaskan kepada pasien penyebab dari rasa sakit/nyeri
pada daerah pinggang tersebut.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Anjurkan pasien banyak minum air putih 3 – 4 liter
perhari selama tidak ada kontra indikasi.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Berikan posisi dan lingkungan yang tenang dan nyaman.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Ajarkan teknik relaksasi, teknik distorsi serta guide
imagine </div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kolaborasi dengan tim dokter :</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l5 level3 lfo2; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Pemberian Cairan Intra Vena</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l5 level3 lfo2; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Pemberian obat-obatan Analgetic, Narkotic atau
Anti Spasmodic.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Observasi tanda-tanda vital sebelum dan sesudah
pemberian obat-obat Narkotic, Analgetic dan Anti Spasmodic.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302"><div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Peningkatan nyeri adalah indikatif dari obstruksi,
sedangkan nyeri yang hilang tiba-tiba menunjukkan batu bergerak. Nyeri dapat
menyebabkan shock.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kemungkinan adanya penyakit/komplikasi lain.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kemungkinan salah satu tanda shock</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Memberikan informasi tentang penyebab dari rasa
sakit/nyeri pada daerah pinggang tersebut.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Cairan membantu membesihkan ginjal dandapat
mengeluarkan batu kecil.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mengurangi sumber stressor</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mengurangi/menghilang kan nyeri tanpa obat-obatan</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l1 level2 lfo11; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Untuk memudahkan pemberian obat serta
pemenuhan cairan bila mual, muntah dan keringat dingin terjadi.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l1 level2 lfo11; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Analgetik memblok lintasan nyeri sehingga
mengurangi nyeri/kolik yang berlebihan</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l4 level2 lfo1; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mengetahui efek samping yang tidak diharapkan
dari pemberian obat-obatan tersebut.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
Hazil</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 2.0cm;" valign="top" width="76"><div class="MsoNormal">
2 April 2002.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal">
Gangguan perfusi jaringan berhubungan dengan adanya
obstruksi (calculi) pada renal atau pada uretra.</div>
<div class="MsoNormal">
Data Penunjang :</div>
<div class="MsoNormal" style="tab-stops: 22.5pt;">
Urine out put <span style="font-family: Symbol;"><</span>
30 cc per jam</div>
<div class="MsoNormal" style="tab-stops: 22.5pt;">
Daerah perifer dingin pucat</div>
<div class="MsoNormal">
TD <span style="font-family: Symbol;"><</span> 100/70 mmHg, </div>
<div class="MsoNormal">
HR > 120 X/mt, </div>
<div class="MsoNormal">
RR > 28 X/mt.</div>
<div class="MsoNormal">
Pengisian kapiler > 3 detik</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal">
Tujuan :</div>
<div class="MsoNormal">
Gangguan perfusi dapat diatasi</div>
<div class="MsoNormal">
Kriteria :</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Produksi urine 30 – 50 cc perjam.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Perifer hangat</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Tanda-tanda vital dalam batas normal : </div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l12 level2 lfo3; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Sistolik 100 – 140 mmHg.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l12 level2 lfo3; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Diastolik 70 – 90 mmHg.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l12 level2 lfo3; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Nadi 60 – 100 X/mt</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l12 level2 lfo3; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Pernafasan 16 – 24 X/mt</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pengisian kapiler <span style="font-family: Symbol;"><</span> 3 detik</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302"><div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Observasi tanda-tanda vital (nadi, tekanan darah dan
pernafasan).</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Observasi Produksi urine setiap jam.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Observasi perubahan tingkat kesadaran.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kolaborasi dengan tim kesehatan:</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l2 level1 lfo4; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Pemeriksaan laboratorium : kadar
ureum/kreatinin, Hb, urine HCT.</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l2 level1 lfo4; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Pemberian diet rendah protein, rendah kalsium
dan posfat</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l2 level1 lfo4; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Pemberian ammonium chloride dan mandelamine.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302"><div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mendeteksi dini terhadap masalah</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mendeteksi dini terhadap masalah</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mendeteksi dini terhadap masalah</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l5 level4 lfo2; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Untuk mendeteksi dini terhadap masalah</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l5 level4 lfo2; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Untuk mencegah/ mengurangi masalah</div>
<div class="MsoNormal" style="margin-left: 43.65pt; mso-list: l5 level4 lfo2; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: Symbol;">·<span style="font: 7pt "Times New Roman";">
</span></span>Untuk mencegah/ mengurangi masalah</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
Hazil</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 2.0cm;" valign="top" width="76"><div class="MsoNormal">
3 April 2002.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal">
Kecemasan berhubungan dengan kehilangan status kesehatan.</div>
<div class="MsoNormal">
Data Penunjang :</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Ekspresi wajah tegang, gelisah, tidak bisa tidur.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Tidak kooperatif dalam pengobatan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>HR = 125 X/mt</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal">
Tujuan :</div>
<div class="MsoNormal">
Rasa cemas dapat diatasi/berkurang.</div>
<div class="MsoNormal">
Kriteria :</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien dapat nenyatakan kecemasan yang dirasakan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien dapat beristirahat dengan tenang.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Nadi dalam batas normal.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Ekspresi wajah ceria/rileks.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302"><div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Berikan dorongan terhadap tiap-tiap proses kehilangan
status kesehatan yang timbul.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Berikan privacy dan lingkungan yang nyaman.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Batasi staf perawat/petugas kesehatan yang menangani
pasien.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Observasi bahasa non verbal dan bahasa verbal dari
gejala-gejala kecemasan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Temani pasien bila gejala-gejala kecemasan timbul.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Berikan kesempatan bagi pasien untuk mengekspresikan
perasaannya .</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Hindari konfrontasi dengan pasien.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Berikan informasi tentang program pengobatan dan
hal-hal lain yang mencemaskan pasien.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Lakukan intervensi keperawatan dengan hati-hati dan
lakukan komunikasi terapeutik.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Anjurkan pasien istirahat sesuai dengan yang
diprogramkan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Berikan dorongan pada pasien bila sudah dapat merawat
diri sendiri untuk meningkatkan harga dirinya sesuai dengan kondisi penyakit.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Hargai setiap pendapat dan keputusan pasien.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302"><div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mengurangi rasa cemas</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>privacy dan lingkungan yang nyaman dapat mengurangi
rasa cemas.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk dapat lebih memberikan ketenangan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mendeteksi dini terhadap masalah</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mengurangi rasa cemas</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kemampuan pemecahan masalah pasien meningkat bila
lingkungan nyaman dan mendukung diberikan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mengurangi ketegangan pasien</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Informasi yang diberikan dapat membantu mengurangi
kecemasan/ansietas</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk menghindari kemungkinan yang tidak diinginkan</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mengurangi ketegangan dan kecemasan pasien</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mengurangi ketergantungan pasien</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk meningkatkan harga diri pasien.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div align="center" class="MsoNormal" style="text-align: center;">
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Hazil</div>
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</td>
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<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 2.0cm;" valign="top" width="76"><div class="MsoNormal">
4 April 2002.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal">
Kurangnya pengetahuan tentang sifat penyakit, tujuan
tindakan yang diprogramkan dan pemeriksaan diagnostik berhubungan dengan
kurangnya informasi.</div>
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Data Penunjang :</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien menyatakan belum memahami tentang penyakitnya.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien bertanya-tanya tentang proses penyakit dan
pengobatan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien kurang kooperatif dalam program pengobatan</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 5.0cm;" valign="top" width="189"><div class="MsoNormal">
Tujuan :</div>
<div class="MsoNormal">
Pengetahuan pasien tentang penyakitnya meningkat</div>
<div class="MsoNormal">
Kriteria</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien dapat menjelaskan kembali tentang sifat
penyakit, tujuan tindakan yang diprogramkan dan pemeriksaan diagnostik.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien tidak bertanya lagi tentang keadaan penyakit
dan program pengobatannya.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pasien kooperatif dalam program pengobatan.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302"><div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Kaji tingkat pengetahuan pasien dan keluarga tentang
penyakit dan pengobatannya.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Berikan penjelasan tentang penyakit, tujuan pengobatan
dan program pengobatan.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Berikan kesempatan pasien dan keluarga untuk
mengekspresikan perasaannya dan mengajukan pertanyaan terhadap hal-hal yang
belum dipahami.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Diskusikan pentingnya banyak minum air putih 3 – 4
liter perhari selama tidak ada kontra indikasi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Diskusikan tentang pentingnya diet rendah protein,
rendah kalsium dan posfat.</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Batasi aktifitas fisik yang berat.</div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 8.0cm;" valign="top" width="302"><div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Pengetahuan membantu mengembangkan kepatuhan pasien
dan keluarga terhadap rencana terapeutik</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk menambah pengetahuan pasien</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Meningkatkan kemampuan pasien untuk memecahkan
masalah</div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk menambah pengetahuan pasien bahwa cairan dapat
membantu pembersihan ginjal dan dapat mengeluargan batu kecil</div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk menambah pengetahuan pasien dan mencegah
kekambuhan</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 21.85pt; mso-list: l5 level2 lfo2; tab-stops: list 21.85pt; text-indent: -21.85pt;">
-<span style="font: 7pt "Times New Roman";">
</span>Untuk mencegah kekambuhan</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 3.0cm;" valign="top" width="113"><div align="center" class="MsoNormal" style="text-align: center;">
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Hazil</td>
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<b>DAFTAR PUSTAKA</b></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; tab-stops: 54.0pt; text-indent: -54.0pt;">
Carpenito, Linda Jual. (1995). <b>Rencana Asuhan & Dokumentasi
Keperawatan</b> (terjemahan). PT EGC. Jakarta.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; tab-stops: 54.0pt; text-indent: -54.0pt;">
Doenges, et al. (2000). <b>Rencana Asuhan Keperawatan</b> (terjemahan).
PT EGC. Jakarta.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; tab-stops: 54.0pt; text-indent: -54.0pt;">
Engram, Barbara. (1998). <b>Rencana Asuhan Keperawatan</b><b style="mso-bidi-font-weight: normal;"> Medikal Bedah. </b>Volume I (terjemahan). PT EGC. Jakarta.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; tab-stops: 54.0pt; text-indent: -54.0pt;">
Long, Barbara C. (1996). <b style="mso-bidi-font-weight: normal;">Perawatan Medikal Bedah</b>. Volume I. (terjemahan).Yayasan Ikatan
Alumni Pendidikan Keperawatan Pajajaran. Bandung.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; tab-stops: 54.0pt; text-indent: -54.0pt;">
Soeparman. (1990). <b>Ilmu Penyakit Dalam. </b>Jilid II. FKUI. Jakarta.</div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-77823556192518457472011-11-10T07:08:00.001-08:002011-11-10T07:09:24.611-08:00<!--[if !mso]>
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<br />
<ol start="1" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;">LAPORAN PENDAHULUAN<span style="font-family: "Acanthus Black SSi","serif"; font-size: 22.0pt; mso-bidi-font-size: 12.0pt;"></span><div class="MsoBodyText2">
<span style="font-family: "Acanthus Black SSi","serif";">ASUHAN
KEPERAWATAN PADA PASIEN DENGAN ANGINA PEKTORIS </span></div>
<span style="font-family: "Arial Narrow","sans-serif";"><br /></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">PENGERTIAN</span></li>
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<div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Angina pektoris adalah nyeri dada yang
ditimbukan karena iskemik miokard dan bersifat sementara atau reversibel.<span style="mso-spacerun: yes;"> </span>(Dasar-dasar keperawatan kardiotorasik, 1993)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Angina pektoris adalah suatu
sindroma kronis dimana klien mendapat serangan sakit dada yang khas yaitu
seperti ditekan, atau terasa berat di dada yang seringkali menjalar ke lengan
sebelah kiri yang timbul pada waktu aktifitas dan segera hilang bila aktifitas
berhenti.<span style="mso-spacerun: yes;"> </span>(Prof. Dr. H.M. Sjaifoellah
Noer, 1996)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Angina pektoris adalah suatu
istilah yang digunakan untuk menggambarkan jenis rasa tidak nyaman yang
biasanya terletak dalam daerah retrosternum. (Penuntun Praktis Kardiovaskuler)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<br /></div>
<ol start="2" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">ETIOLOGI</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Ateriosklerosis</span></div>
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<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Spasme arteri koroner</span></div>
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<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Anemia berat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Artritis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Aorta Insufisiensi</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<ol start="3" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">FAKTOR-FAKTOR
RESIKO</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Dapat Diubah (dimodifikasi)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: 0cm;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Diet (hiperlipidemia)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: 0cm;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Rokok</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: 0cm;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Hipertensi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: 0cm;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Stress</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: 0cm;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Obesitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: 0cm;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kurang
aktifitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: 0cm;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Diabetes Mellitus</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: 0cm;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Pemakaian kontrasepsi oral</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Tidak dapat diubah</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Usia</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Jenis Kelamin</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Ras</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Herediter</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l12 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kepribadian tipe A</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<ol start="4" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">FAKTOR
PENCETUS SERANGAN</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif";">Faktor
pencetus yang dapat menimbulkan serangan antara lain :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Emosi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Stress</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kerja fisik terlalu berat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Hawa terlalu panas dan lembab</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Terlalu kenyang</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Banyak merokok</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 99.0pt; text-align: justify;">
<br /></div>
<ol start="5" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">GAMBARAN
KLINIS</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Nyeri dada substernal ataru
retrosternal menjalar ke leher, tenggorokan daerah inter skapula atau lengan
kiri.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kualitas nyeri seperti tertekan
benda berat, seperti diperas, terasa panas, kadang-kadang hanya perasaan tidak
enak di dada (chest discomfort).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Durasi nyeri berlangsung 1
sampai 5 menit, tidak lebih daari 30 menit.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Nyeri hilang (berkurang) bila
istirahat atau pemberian nitrogliserin.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Gejala penyerta : sesak nafas,
perasaan lelah, kadang muncul keringat dingin, palpitasi, dizzines.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Gambaran EKG : depresi segmen
ST, terlihat gelombang T terbalik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Gambaran EKG seringkali normal
pada waktu tidak timbul serangan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: list 99.0pt; text-align: justify;">
<br /></div>
<ol start="6" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">TIPE
SERANGAN </span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Angina Pektoris Stabil</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level1 lfo4; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Awitan secara klasik berkaitan
dengan latihan atau aktifitas yang meningkatkan kebutuhan oksigen niokard.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level1 lfo4; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Nyeri segera hilang dengan
istirahat atau penghentian aktifitas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l7 level1 lfo4; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Durasi nyeri 3 – 15 menit.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l9 level3 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Angina Pektoris Tidak Stabil</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l11 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Sifat, tempat dan penyebaran
nyeri dada dapat mirip dengan angina pektoris stabil.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l9 level4 lfo1; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Adurasi serangan dapat timbul
lebih lama dari angina pektoris stabil.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l9 level4 lfo1; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Pencetus dapat terjadi pada
keadaan istirahat atau pada tigkat aktifitas ringan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l9 level4 lfo1; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kurang responsif terhadap
nitrat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l9 level4 lfo1; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Lebih sering ditemukan
depresisegmen ST.</span></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Dapat disebabkan oleh ruptur
plak aterosklerosis, spasmus, trombus atau trombosit yang beragregasi.</span></div>
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<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Angina Prinzmental (Angina
Varian).</span></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Sakit dada atau nyeri timbul
pada waktu istirahat, seringkali pagi hari.</span></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Nyeri disebabkan karena spasmus
pembuluh koroneraterosklerotik.</span></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">EKG menunjukkan elevaasi segmen
ST.</span></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Cenderung berkembang menjadi
infaark miokard akut.</span></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Dapat terjadi aritmia.</span></div>
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<ol start="7" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">PATOFISIOLOGI
DAN PATHWAYS</span></li>
</ol>
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Mekanisme timbulnya angina
pektoris didasarkan pada ketidakadekuatan suply oksigen ke sel-sel miokardium
yang diakibatkan karena kekauan arteri dan penyempitan lumen arteri koroner
(ateriosklerosis koroner).<span style="mso-spacerun: yes;"> </span>Tidak
diketahui secara pasti apa penyebab ateriosklerosis, namun jelas bahwa tidak
ada faktor tunggal yang bertanggungjawab atas perkembangan ateriosklerosis.<span style="mso-spacerun: yes;"> </span>Ateriosklerosis merupakan penyakir arteri
koroner yang paling sering ditemukan.<span style="mso-spacerun: yes;">
</span>Sewaktu beban kerja suatu jaringan meningkat, maka kebutuhan oksigen
juga meningkat.<span style="mso-spacerun: yes;"> </span>Apabila kebutuhan
meningkat pada jantung yang sehat maka artei koroner berdilatasi dan megalirkan
lebih banyak darah dan oksigen keotot jantung. Namun apabila arteri koroner
mengalami kekauan atau menyempit akibat ateriosklerosis dan tidak dapat
berdilatasi sebagai respon terhadap peningkatan kebutuhan akan oksigen, maka
terjadi iskemik (kekurangan suplai darah) miokardium.</div>
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Adanya endotel yang cedera
mengakibatkan hilangnya produksi No (nitrat Oksid0 yang berfungsi untuk
menghambat berbagai zat yang reaktif.<span style="mso-spacerun: yes;">
</span>Dengan tidak adanya fungsi ini dapat menyababkan otot polos berkontraksi
dan timbul spasmus koroner yang memperberat penyempitan lumen karena suplai
oksigen ke miokard berkurang.<span style="mso-spacerun: yes;">
</span>Penyempitan atau blok ini belum menimbulkan gejala yang begitu nampak
bila belum mencapai 75 %.<span style="mso-spacerun: yes;"> </span>Bila penyempitan
lebih dari 75 % serta dipicu dengan aktifitas berlebihan maka suplai darah ke
koroner akan berkurang.<span style="mso-spacerun: yes;"> </span>Sel-sel
miokardium menggunakan glikogen anaerob untuk memenuhi kebutuhan energi
mereka.<span style="mso-spacerun: yes;"> </span>Metabolisme ini menghasilkan
asam laktat yang menurunkan pH miokardium dan menimbulkan nyeri.<span style="mso-spacerun: yes;"> </span>Apabila kenutuhan energi sel-sel jantung berkurang,
maka suplai oksigen menjadi adekuat dan sel-sel otot kembali fosforilasi
oksidatif untuk membentuk energi.<span style="mso-spacerun: yes;"> </span>Proses
ini tidak menghasilkan asam laktat.<span style="mso-spacerun: yes;">
</span>Dengan hilangnya asam laktat nyeri akan reda.</div>
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<h1>
PATHWAYS<span style="mso-spacerun: yes;"> </span>ANGINA PEKTORIS</h1>
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q Usia
q Jenis kelamin
q Ras
q Herediter
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q Diet/hiperlipidemia
q Rokok
q Hipertensi
q Stress
q Obesitas
q DM
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q Pemakaian kontrasepsi oral" height="198" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="198" /><b><span style="font-family: "Arial Narrow","sans-serif"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt;"></span></b></div>
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<img align="left" alt="Text Box: Turbulensi aliran darah" height="76" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image008.gif" width="100" /><img align="left" alt="Text Box: Cidera sel endotel arteri" height="40" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image009.gif" width="196" /><span style="font-family: "Arial Narrow","sans-serif";"></span></div>
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<img align="left" alt="Text Box: Ekskresi zat vaso aktif
(serotonin,asetilkolin)" height="52" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image013.gif" width="172" /><img align="left" alt="Text Box: Invasi akumulasi lipid" height="40" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image014.gif" width="160" /><img align="left" alt="Text Box: - trombosit
- penimbunan fibrin" height="76" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image015.gif" width="112" /><img align="left" alt="Text Box: Proliferasi otot polos ke intima" height="52" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image016.gif" width="112" /><span style="font-family: "Arial Narrow","sans-serif";"></span></div>
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<img align="left" alt="Text Box: Spasme koroner" height="28" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image021.gif" width="124" /><img align="left" alt="Text Box: Arteritis" height="52" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image022.gif" width="100" /><img align="left" alt="Text Box: Lesi komplikata" height="52" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image023.gif" width="124" /><span style="font-family: "Arial Narrow","sans-serif";"></span></div>
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arteri menjadi kaku
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<img align="left" alt="Text Box: Beban kerja jantung meningkat" height="76" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image036.gif" width="244" /><span style="font-family: "Arial Narrow","sans-serif";"><span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>Metabolisme anaerob</span></div>
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<img align="left" alt="Text Box: Gangguan kontraksi ventrikel kiri" height="40" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image037.gif" width="232" /><span style="font-family: "Arial Narrow","sans-serif";"><span style="mso-spacerun: yes;"> </span></span></div>
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<img align="left" alt="Text Box: Aorta insufisiensi" height="52" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image038.gif" width="136" /><span style="font-family: "Arial Narrow","sans-serif";"></span></div>
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<span style="font-family: "Arial Narrow","sans-serif";"><span style="mso-spacerun: yes;">
</span>Asam Laktat</span></div>
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<img align="left" alt="Text Box: Penurunan stroke volume" height="52" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image039.gif" width="208" /><span style="font-family: "Arial Narrow","sans-serif";"></span></div>
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<img align="left" alt="Text Box: Nyeri " height="52" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image040.gif" width="100" /><img align="left" alt="Text Box: Penurunan aliran koroner" height="40" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image041.gif" width="208" /><span style="font-family: "Arial Narrow","sans-serif";"><span style="mso-spacerun: yes;">
</span></span></div>
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<img align="left" alt="Text Box: Penurunan COP " height="40" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image042.gif" width="196" /><span style="font-family: "Arial Narrow","sans-serif";"></span></div>
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<img align="left" alt="Text Box: MK 1 : Nyeri Akut" height="54" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image043.gif" width="138" /><img align="left" alt="Text Box: Rasa lelah, lemas" height="40" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image044.gif" width="148" /><span style="font-family: "Arial Narrow","sans-serif";"></span></div>
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<img align="left" alt="Text Box: MK 2 : Intoleransi Aktifitas" height="54" hspace="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image045.gif" width="186" /><span style="font-family: "Arial Narrow","sans-serif";"></span></div>
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<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
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<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
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<br /></div>
<ol start="8" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">DIAGNOSA
KEPERAWATAN YANG MUNGKIN MUNCUL</span></li>
</ol>
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<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Nyeri akut berhubungan dengan
iskemik miokard.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Intoleransi aktifitas
berhubungan dengan berkurangnya curah jantung.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Ansietas berhubungan dengan
rasa takut akan ancaman kematian yang tiba-tiba.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kurang pengetahuan (kebutuhan
belajar) mengenai kodisi, kebutuhan pengobatan berhubungan dengan kurangnya
informasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<br /></div>
<ol start="9" style="margin-top: 0cm;" type="A">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Arial Narrow","sans-serif";">FOKUS
INTERVENSI</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Nyeri akut berhubungan dengan
iskemik miokard.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Arial Narrow","sans-serif";">Intervensi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level1 lfo6; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kaji gambaran dan faktor-faktor
yang memperburuk nyeri.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level1 lfo6; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Letakkan klien pada istirahat
total selama episode angina (24-30 jam pertama) dengan posisi semi fowler.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level1 lfo6; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Observasi tanda vital tiap 5
menit setiap serangan angina.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level1 lfo6; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Ciptakanlingkunan yang tenang,
batasi pengunjung bila perlu.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l3 level1 lfo6; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Berikan makanan lembut dan
biarkan klien istirahat 1 jam setelah makan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level1 lfo6; tab-stops: list 72.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Tinggal dengan klien yang
mengalami nyeri atau tampak cemas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level1 lfo6; tab-stops: list 72.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Ajarkan tehnik distraksi dan
relaksasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level1 lfo6; tab-stops: list 72.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kolaborasi pengobatan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Intoleransi aktifitas
berhubungan dengan kurangnya curah jantung.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Arial Narrow","sans-serif";">Intervensi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Pertahankan tirah baring pada
posisi yang nyaman.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l4 level1 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Berikan periode istirahat
adekuat, bantu dalam pemenuhan aktifitas perawatan diri sesuai indikasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l4 level1 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Catat warna kulit dan kualittas
nadi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l4 level1 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Tingkatkan katifitas klien
secara teratur.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l4 level1 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Pantau EKG dengan sering.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Ansietas berhubungan dengan
rasa takut akan ancaman kematian yang tiba-tiba.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Arial Narrow","sans-serif";">Intervensi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Jelaskan semua prosedur
tindakan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Tingkatkan ekspresi perasaan
dan takut.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Dorong keluarga dan teman utnuk
menganggap klien seperti sebelumnya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Beritahu klien program medis
yang telah dibuat untuk menurunkan/membatasi serangan akan datang dan
meningkatkan stabilitas jantung.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kolaborasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l9 level3 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Arial Narrow","sans-serif"; mso-bidi-font-family: "Arial Narrow"; mso-fareast-font-family: "Arial Narrow";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kurang pengetahuan (kebutuhan
belajar) mengenai kodisi, kebutuhan pengobatan berhubungan dengan kurangnya
informasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 54.0pt;">
<span style="font-family: "Arial Narrow","sans-serif";">Intervensi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level1 lfo9; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Tekankan perlunya mencegah
serangan angina.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level1 lfo9; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Dorong untuk menghindari
faktor/situasi yang sebagai pencetus episode angina.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level1 lfo9; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Kaji pentingnya kontrol berat
badan, menghentikan kebiasaan merokok, perubahan diet dan olah raga.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level1 lfo9; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Tunjukkan/ dorong klien untuk
memantau nadi sendiri selama aktifitas, hindari tegangan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level1 lfo9; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Diskusikan langkah yang diambil
bila terjadi serangan angina.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l6 level1 lfo9; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial Narrow","sans-serif";">Dorong klien untuk mengikuti
program yang telah ditentukan.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
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<br /></div>
<h2>
DAFTAR PUSTAKA</h2>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Corwin, Elizabeth, <i>Buku
Saku Patofisiologi</i>, Jakarta, EGC, 2000.</span></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Chung, EK, <i><span style="mso-spacerun: yes;"> </span>Penuntun Praktis Penyakit Kardiovaskuler,
</i>Jakarta, EGC, 1996</span></li>
</ol>
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<br /></div>
<ol start="3" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Doenges, Marylinn E, <i>Rencana
Asuhan Keperawatan,</i> Jakarta, EGC, 1998</span></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="4" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Engram, Barbara,<i>
Rencana Asuhan Keperawatan Medikal Bedah volume 2, </i>Jakarta, EGC, 1998</span></li>
</ol>
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<br /></div>
<ol start="5" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Long, C, Barbara,<i>
Perawatan Medikal Bedah 2, </i><span style="mso-spacerun: yes;"> </span>Bandung, IAPK, 1996</span></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="6" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Noer, Sjaifoellah,<i> Buku
Ajar Ilmu Penyakit Dalam, </i>Jakarta, FKUI, 1996</span></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="7" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Price, Sylvia Anderson, <i>Patofisiologi
Buku I</i> Jakarta, EGC, 1994</span></li>
</ol>
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<br /></div>
<ol start="8" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">……., <i>Dasar-dasar
Keperawatan Kardiotorasik (Kumpulan Bahan Kuliah edisi ketiga),</i>Jakarta
: RS Jantung Harapan Kita, 1993.</span></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="9" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Tucker, Susan Martin, <i><span style="mso-spacerun: yes;"> </span>Standar Perawatan Pasien Volume I, </i><span style="mso-spacerun: yes;"> </span>Jakarta, EGC, 1998</span></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="10" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="mso-list: l1 level1 lfo13; tab-stops: list 36.0pt;"><span style="font-family: "Arial Narrow","sans-serif";">Underwood, J C E, <i>Pathologi
Volume 1 , </i>Jakarta, EGC, 1999</span></li>
</ol>
<div class="MsoNormal">
<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-27472267786014647352011-11-10T07:05:00.001-08:002011-11-10T07:06:56.283-08:00Askep<!--[if gte mso 9]><xml>
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<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b><span style="font-family: "Verdana","sans-serif"; font-size: 18.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">INFARK MIOKARD AKUT</span></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<h3 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">DEFINISI</span></h3>
<div class="MsoBodyTextIndent3" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Infark miokard adalah
kematian/nekrosis jaringan miokard akibat<span style="mso-spacerun: yes;">
</span>penurunan<span style="mso-spacerun: yes;"> </span>secara tiba-tiba
aliran darah arteri koronaria ke jantung atau terjadinya peningkatan kebutuhan
oksigen secara tiba-tiba tanpa perfusi arteri koronaria yang cukup.</span></div>
<div class="MsoBodyTextIndent3" style="line-height: 150%; text-align: justify;">
<br /></div>
<h3 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">ETIOLOGI</span></h3>
<div class="MsoBodyTextIndent3" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Infark miokard dapat disebabkan oleh
: </span></div>
<div class="MsoBodyTextIndent3" style="line-height: 150%; margin-left: 35.45pt; mso-list: l22 level1 lfo22; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">penyempitan
kritis arteri koroner akibat ateriosklerosis atau oklusi arteri komplit akibat
embolus atau trombus. </span></div>
<div class="MsoBodyTextIndent3" style="line-height: 150%; margin-left: 35.45pt; mso-list: l22 level1 lfo22; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Penurunan
aliran darah koroner dapat juga disebabkan oleh syok dan hemoragi.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoBodyTextIndent3" style="line-height: 150%; margin-left: 35.45pt; mso-list: l22 level1 lfo22; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Ketidakseimbangan
antara suplai dan kebutuhan oksigen miokard.</span></div>
<div class="MsoBodyTextIndent3" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<br /></div>
<h3 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">TANDA DAN GEJALA</span></h3>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Tanda dan gejala infark
miokard<span style="mso-spacerun: yes;"> </span>( TRIAGE ) adalah :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">1.<span style="mso-spacerun: yes;"> </span><u>Klinis</u></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l16 level1 lfo23; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri dada yang terjadi secara
mendadak dan terus-menerus tidak mereda, biasanya diatas region sternal bawah
dan abdomen bagian atas, ini merupakan gejala utama.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l16 level1 lfo23; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Keparahan nyeri dapat meningkat
secaara menetap sampai nyeri tidak tertahankan lagi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l16 level1 lfo23; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri tersebut sangat sakit, seperti
tertusuk-tusuk yang dapat menjalar ke bahu dan terus ke bawah menuju lengan
(biasanya lengan kiri).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l16 level1 lfo23; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri mulai secara spontan (tidak
terjadi setelah kegiatan atau gangguan emosional), menetap selama beberapa jam
atau hari, dan tidak hilang dengan bantuan istirahat atau nitrogliserin (NTG).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l16 level1 lfo23; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri dapat menjalar ke arah rahang
dan<span style="mso-spacerun: yes;"> </span>leher.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l16 level1 lfo23; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri sering disertai dengan sesak
nafas, pucat, dingin, diaforesis berat, pening atau kepala terasa melayang dan
mual muntah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l16 level1 lfo23; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pasien dengan diabetes melitus tidak
akan mengalami nyeri yang hebat karena neuropati yang menyertai diabetes dapat
mengganggu neuroreseptor (menumpulkan pengalaman nyeri)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 198.0pt; mso-list: l6 level1 lfo17; tab-stops: 18.0pt; text-align: justify; text-indent: -180.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Laboratotium</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt;">
<span style="font-family: "Verdana","sans-serif";">Pemeriksaan Enzim jantung</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">CPK-MB/CPK
</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Isoenzim
yang ditemukan<span style="mso-spacerun: yes;"> </span>pada otot jantung<span style="mso-spacerun: yes;"> </span>meningkat antara<span style="mso-spacerun: yes;"> </span>4-6 jam, memuncak dalam 12-24 jam,<span style="mso-spacerun: yes;"> </span>kembali normal dalam 36-48 jam.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">LDH/HBDH</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Meningkat
dalam<span style="mso-spacerun: yes;"> </span>12-24 jam dam memakan<span style="mso-spacerun: yes;"> </span>waktu lama untuk kembali normal</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">AST/SGOT</span></div>
<div class="MsoBodyText3" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 36.0pt;">
<span style="font-family: "Verdana","sans-serif";">Meningkat ( kurang
nyata/khusus ) terjadi dalam 6-12 jam, memuncak dalam 24 jam, kembali normal
dalam 3 atau 4<span style="mso-spacerun: yes;"> </span>hari</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 198.0pt; mso-list: l6 level1 lfo17; tab-stops: 18.0pt; text-align: justify; text-indent: -180.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">EKG</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Perubahan EKG yang terjadi pada fase
awal<span style="mso-spacerun: yes;"> </span>adanya<span style="mso-spacerun: yes;"> </span>gelombang T tinggi dan simetris. Setelah<span style="mso-spacerun: yes;"> </span>ini terdapat elevasi segmen ST.Perubahan yang
terjadi kemudian<span style="mso-spacerun: yes;"> </span>ialah adanya<span style="mso-spacerun: yes;"> </span>gelombang Q/QS yang menandakan adanya nekrosis.</span></div>
<h3 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">DIAGNOSTIK</span></h3>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">`<span style="mso-tab-count: 1;"> </span>Diagnosis
AMI dapat ditegakkan<span style="mso-spacerun: yes;"> </span>secara :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l12 level1 lfo9; tab-stops: 18.0pt list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Anamnesis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level2 lfo9; tab-stops: 18.0pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Keluhan
nyeri dada yang disebabkan oleh IMA ialah<span style="mso-spacerun: yes;">
</span>sebagai berikut :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level2 lfo9; tab-stops: 18.0pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri<span style="mso-spacerun: yes;"> </span>substernal, prekordial, epigastrium. Nyeri
menjalar<span style="mso-spacerun: yes;"> </span>ke lengan kiri , leher dan
rahang.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level2 lfo9; tab-stops: 18.0pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri
dada lebih dari 30 menit</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level2 lfo9; tab-stops: 18.0pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kualitas
nyeri dada seperti ditekan, diremas, terasa berat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level2 lfo9; tab-stops: 18.0pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri
dada tidak hilang<span style="mso-spacerun: yes;"> </span>dengan istirahat atau
pemberian<span style="mso-spacerun: yes;"> </span>nitrat sublingual</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level2 lfo9; tab-stops: 18.0pt list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Dapat
disertai palpitasi , sesak nafas, banyak keringat dan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 18.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 1;"> </span>pucat ( Schneider & Seckler, 1981 )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Skor
nyeri menurut White</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l6 level2 lfo17; tab-stops: 18.0pt list 90.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">0<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">:
Tak mengalami nyeri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 90.0pt; mso-list: l6 level2 lfo17; tab-stops: 18.0pt list 90.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">1<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">:
Nyeri pada satu sisi, tanpa mengganggu aktifitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 99.0pt; mso-list: l6 level2 lfo17; tab-stops: 18.0pt list 90.0pt; text-align: justify; text-indent: -45.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">:
Nyeri lebih pada satu tempat & mengakibatkan terganggunya aktifitas,
misalnya kesulitan bangun dari tempat tidur, sulit menekuk kepala dll.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l12 level1 lfo9; tab-stops: 18.0pt list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pemeriksaan
EKG</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Perubahan
EKG yang terjadi pada fase awal<span style="mso-spacerun: yes;">
</span>adanya<span style="mso-spacerun: yes;"> </span>gelombang T tinggi dan
simetris.Setelah<span style="mso-spacerun: yes;"> </span>ini terdapat elevasi
segmen ST.Perubahan yang terjadi kemudian<span style="mso-spacerun: yes;">
</span>ialah adanya<span style="mso-spacerun: yes;"> </span>gelombang Q/QS yang
menandakan adanya nekrosis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l12 level1 lfo9; tab-stops: 18.0pt list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pemeriksaan
Enzim jantung</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">CPK-MB/CPK
</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Isoenzim
yang ditemukan<span style="mso-spacerun: yes;"> </span>pada otot jantung<span style="mso-spacerun: yes;"> </span>meningkat antara<span style="mso-spacerun: yes;"> </span>4-6 jam, memuncak dalam 12-24 jam,<span style="mso-spacerun: yes;"> </span>kembali normal dalam 36-48 jam.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">LDH/HBDH</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Meningkat
dalam<span style="mso-spacerun: yes;"> </span>12-24 jam dam memakan<span style="mso-spacerun: yes;"> </span>waktu lama untuk kembali normal</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">AST/SGOT</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Meningkat
( kurang nyata/khusus ) terjadi dalam 6-12 jam memuncak dalam 24 jam kembali
normal dalam 3 atau 4<span style="mso-spacerun: yes;"> </span>hari</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 36.0pt; text-align: justify;">
<br /></div>
<h3 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">PENATALAKSANAAN</span></h3>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Tujuan penatalaksanaan
medis adalah untuk meminimalkan kerusakan<span style="mso-spacerun: yes;">
</span>miokard dengan: menghilangkan nyeri, memberikan istirahat dan mencegah
timbulnya komplikasi seperti disritmia letal dan syok kardiogenik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level2 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pemberian oksigen dilakukan saat
awitan nyeri dada.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level2 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Analgesik (morfin sulfat).</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";"><span style="mso-spacerun: yes;">
</span>Farmakoterapi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l7 level1 lfo10; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Vasodilator
untuk meningkatkan sulpai oksigen (NTG).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l7 level1 lfo10; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Antikoagulan
(Heparin).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l7 level1 lfo10; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Trombolitik
(streptokinase, aktivator plasminogen jenis jaringan <t-pa> ,
anistreplase) hanya akan efektif bila diberikan dalam 6 jam awitan nyeri dada,
selama terjadi neurosis jaringan transmural.</t-pa></span></div>
<h1 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">PROSES KEPERAWATAN</span></h1>
<h4 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Pengkajian</span></h4>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Tetapkan penatalaksanaan dasar untuk
mendapatkan informasi tentang status terakhir pasien sehingga semua
penyimpangan yang terjadi dapat segera diketahui.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level2 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Riwayat atau adanya faktor-faktor resiko
:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l13 level1 lfo24; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Penyakit
pembuluh darah arteri.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l13 level1 lfo24; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Serangan
jantung sebelumnya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l13 level1 lfo24; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Riwayat
keluarga atas penyakit jantung/serangan jantung positif.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l13 level1 lfo24; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kolesterol
serum tinggi (diatas 200 mg/L).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l13 level1 lfo24; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Perokok</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l13 level1 lfo24; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Diet
tinggi garam dan tinggi lemak.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l13 level1 lfo24; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kegemukan.(
BB idealTB –100 ± 10 % )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l13 level1 lfo24; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Wanita
pasca menopause karena terapi estrogen.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level2 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pemeriksaan fisik berdasarkan
pengkajian kardiovaskuler dapat menunjukan :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l32 level1 lfo5; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri
dada berkurang dengan istirahat atau pemberian nitrat (temuan yang paling
penting) sering juga disertai :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Perasaan
ancaman pingsan dan atau kematian</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Diaforesis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Mual
dan muntah kadang-kadang.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Dispneu.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Sindrom
syok dalam berbagai tingkatan (pucat, dingin, kulit lembab atau basah, turunnya
tekanan darah, denyut nadi yang cepat, berkurangnya nadi perifer dan bunyi
jantung).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l10 level1 lfo3; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Demam
(dalam 24 – 48 jam ).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level2 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kaji nyeri dada sehubungan dengan :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l25 level1 lfo25; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Faktor
perangsang.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l25 level1 lfo25; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kualitas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l25 level1 lfo25; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Lokasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l25 level1 lfo25; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Beratnya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l18 level2 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pemeriksaan Diagnostik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l29 level1 lfo26; tab-stops: list 2.0cm; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">EKG,
menyatakan perpindahan segmen ST, gelombang Q, dan perubahan gelombang T.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l29 level1 lfo26; tab-stops: list 2.0cm; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Berdasarkan
hasil sinar X dada terdapat pembesaran jantung dan kongestif paru.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l29 level1 lfo26; tab-stops: list 2.0cm; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Enzim
jantung <i>(Gawlinski, 1989)</i></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; mso-list: l29 level4 lfo26; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kreatinin
kinase (CK) – isoenzim MB mulai naik dalam 6 jam, memuncak dalam 18 – 24 jam
dan kembali normal antara 3 – 4 hari, tanpa terjadinya neurosis baru.<span style="mso-spacerun: yes;"> </span>Enzim CK – MB ssering dijadikan sebagai
indikator Infark Miokard.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; mso-list: l29 level4 lfo26; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Laktat
dehidrogenase (LDH) mulai meningkat dalam 6 – 12 jam, memuncak dalam 3 – 4 hari
dan normal 6 –12 hari.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 70.9pt; mso-list: l29 level4 lfo26; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Aspartat
aminotransferase serum (AST) mulai meningkat dalam 8 – 12 jam dan bertambah
pekat dalam 1 – 2 hari.<span style="mso-spacerun: yes;"> </span>Enzim ini muncul
dengan kerusakan yang hebat dari otot tubuh.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; mso-list: l29 level1 lfo26; tab-stops: list 2.0cm; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Test
tambahan termasuk pemeriksaan elektrolit serum, lipid serum, urinalisis,
analisa gas darah (AGD).</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<h4 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">DIAGNOSA
KEPERAWATAN</span></h4>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Verdana","sans-serif";">1.
Gangguan perfusi jaringan</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Dapat dihubungkan<span style="mso-spacerun: yes;"> </span>dengan</span></i></b><span style="font-family: "Verdana","sans-serif";"> : Iskemik, kerusakan otot jantung, penyempitan /
penyumbatan<span style="mso-spacerun: yes;"> </span>pembuluh darah arteri
koronaria</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><span style="font-family: "Verdana","sans-serif";">Kemungkinan dibuktikan oleh</span></b><i><span style="font-family: "Verdana","sans-serif";"> :</span></i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Daerah perifer dingin</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">EKG elevasi segmen ST & Q
patologis pada lead tertentu</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">RR lebih dari 24 x/ menit</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kapiler refill Lebih dari 3 detik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri dada</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Gambaran foto torak terdpat
pembesaran jantung & kongestif paru ( tidak selalu )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">HR lebih dari 100 x/menit, TD >
120/80AGD dengan : pa O<sub>2</sub> < 80 mmHg, pa Co<sub>2</sub> > 45
mmHg dan Saturasi < 80 mmHg</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Nadi lebih dari 100 x/ menit</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l30 level1 lfo28; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Terjadi peningkatan enzim jantung
yaitu CK, AST, LDL/HDL</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Gangguan perfusi<span style="mso-spacerun: yes;"> </span>jaringan berkurang / tidak meluas selama
dilakukan tindakan perawatan di RS.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Daerah perifer hangat, tak sianosis,
gambaran EKG tak menunjukan perluasan infark RR 16-24 x/ menit tak terdapat
clubbing finger, kapiler refill 3-5 detik, nadi 60-100x / menit, TD 120/80 mmHg</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Rencana Tindakan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l19 level1 lfo29; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Monitor Frekuensi dan irama jantung</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l19 level1 lfo29; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Observasi perubahan<span style="mso-spacerun: yes;"> </span>status mental</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l19 level1 lfo29; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Observasi warna<span style="mso-spacerun: yes;"> </span>dan suhu kulit / membran mukosa</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l19 level1 lfo29; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Ukur haluaran urin dan catat berat
jenisnya</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l19 level1 lfo29; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kolaborasi : Berikan cairan IV l
sesuai indikasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l19 level1 lfo29; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pantau Pemeriksaan diagnostik / dan
laboratorium mis EKG, elektrolit , GDA( Pa O<sub>2</sub>, Pa CO<sub>2</sub> dan
saturasi O<sub>2 </sub>). Dan<span style="mso-spacerun: yes;"> </span>Pemberian
oksigen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: list 36.0pt; text-indent: -54.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Verdana","sans-serif";">2.
Nyeri</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Dapat dihubungkan dengan: Iskemia
jaringan sekunder terhadap<span style="mso-spacerun: yes;"> </span>sumbatan arteri
coroner.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kemungkinan<span style="mso-spacerun: yes;"> </span>dibuktikan oleh : nyeri dada dengan atau
tanpa penyebaran, wajah meringis, gelisah, delirium<span style="mso-spacerun: yes;"> </span>perubahan nadi<span style="mso-spacerun: yes;"> </span>TD</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Nyeri berkurang setelah dilakukan
tindakan perawatan selama</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Nyeri dada berkurang misalnya dari
skala 3 ke 2, atau dari 2 ke 1, ekpresi wajah<span style="mso-spacerun: yes;">
</span>rileks / tenang, tak tegang , tidak gelisah<span style="mso-spacerun: yes;"> </span>nadi 60-100 x / menit, Td 120/ 80 mmHg</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Rencana tindakan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l9 level1 lfo30; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Observasi karakteristik, lokasi,
waktu, dan perjalanan<span style="mso-spacerun: yes;"> </span>rasa nyeri
dada<span style="mso-spacerun: yes;"> </span>tersebut.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l9 level1 lfo30; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Anjurkan pada klien<span style="mso-spacerun: yes;"> </span>menghentikan aktifitas selama ada serangan
dan istirahat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l9 level1 lfo30; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Bantu klien<span style="mso-spacerun: yes;"> </span>melakukan tehnik relaksasi, mis nafas dalam,
perilaku distraksi, visualisasi, atau bimbingan imajinasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l9 level1 lfo30; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pertahankan Olsigenasi<span style="mso-spacerun: yes;"> </span>dengan bikanul contohnya ( 2-4 L/ menit )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l9 level1 lfo30; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Monitor tanda-tanda vital ( Nadi
& tekanan darah ) tiap dua jam.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l9 level1 lfo30; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kolaborasi<span style="mso-spacerun: yes;"> </span>dengan tim kesehatan<span style="mso-spacerun: yes;"> </span>dalam pemberian analgetik.</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 45.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 21.3pt; text-indent: -18.0pt;">
<b><span style="font-family: "Verdana","sans-serif";">3.<span style="mso-tab-count: 1;"> </span>Kemungkinan terhadap kelebihan<span style="mso-spacerun: yes;"> </span>volume cairan ekstravaskuler</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Faktor resiko meliputi :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Penurunan perfusi ginjal,
peningkatan<span style="mso-spacerun: yes;"> </span>natrium/ retensi air,
peningkatan<span style="mso-spacerun: yes;"> </span>tekanan hidrostatik atau
penurunan protein plasma ( menyerap cairan<span style="mso-spacerun: yes;">
</span>dalam area interstisial/ jaringan )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kemunkinan dibuktikan oleh : tidak
adanya tanda-tanda<span style="mso-spacerun: yes;"> </span>dan gejala gejala
membuat<span style="mso-spacerun: yes;"> </span>diagnosa actual.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Keseimbangan volume cairan dapat
dipertahankan<span style="mso-spacerun: yes;"> </span>selama dilakukan tindakan
keperawatan selama di RS</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Mempertahankan<span style="mso-spacerun: yes;"> </span>keseimbangan cairan seperti dibuktikan<span style="mso-spacerun: yes;"> </span>oleh tekanan darah dalam batas normal, tak
ada distensi<span style="mso-spacerun: yes;"> </span>vena perifer/ vena dan edema<span style="mso-spacerun: yes;"> </span>dependen, paru bersih dan<span style="mso-spacerun: yes;"> </span>berat badan<span style="mso-spacerun: yes;">
</span>ideal ( BB idealTB –100 ± 10 %)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Perencanaan tindakan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l2 level1 lfo31; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Ukur masukan / haluaran, catat
penurunan , pengeluaran, sifat konsentrasi, hitung keseimbangan cairan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l2 level1 lfo31; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Observasi adanya oedema dependen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l2 level1 lfo31; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Timbang BB tiap hari</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l2 level1 lfo31; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Pertahankan masukan<span style="mso-spacerun: yes;"> </span>total caiaran 2000 ml/24 jam dalam toleransi
kardiovaskuler</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l2 level1 lfo31; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kolaborasi : pemberian diet rendah
natrium, berikan<span style="mso-spacerun: yes;"> </span>diuetik.</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-family: "Verdana","sans-serif";">4.
Kerusakan pertukarann gas </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Dapat dihubungkan oleh : </span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Gangguan aliran darah ke alveoli
atau kegagalan utama paru, perubahan membran<span style="mso-spacerun: yes;">
</span>alveolar- kapiler ( atelektasis , kolaps jalan nafas/ alveolar<span style="mso-spacerun: yes;"> </span>edema paru/efusi, sekresi berlebihan /
perdarahan aktif </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kemungkinan dibuktikan oleh :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Dispnea berat, gelisah, sianosis,
perubahan GDA, hipoksemia</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Oksigenasi dengan GDA dalam rentang
normal (pa O<sub>2</sub> < 80 mmHg, pa Co<sub>2</sub> > 45 mmHg dan
Saturasi < 80 mmHg ) setelah dilakukan tindakan keperawtan selama di RS.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria hasil :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Tidak sesak nafas,<span style="mso-spacerun: yes;"> </span>tidak gelisah,<span style="mso-spacerun: yes;"> </span>GDA dala batas Normal ( pa O<sub>2</sub> <
80 mmHg, pa Co<sub>2</sub> > 45 mmHg dan Saturasi < 80 mmHg )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tindakan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l31 level1 lfo32; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Catat frekuensi & kedalaman
pernafasan, penggunaan otot Bantu pernafasan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l31 level1 lfo32; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Auskultasi paru untuk<span style="mso-spacerun: yes;"> </span>mengetahui penurunan / tidak adanya<span style="mso-spacerun: yes;"> </span>bunyi nafas<span style="mso-spacerun: yes;">
</span>dan adanya bunyi tambahan missal krakles, ronki dll.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l31 level1 lfo32; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Lakukan tindakan untuk memperbaiki /
mempertahankan jalan nafas misalnya , batuk,<span style="mso-spacerun: yes;">
</span>penghisapan lendir dll.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l31 level1 lfo32; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Tinggikan kepala / tempat tidur
sesuai kebutuhan / toleransi pasien</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l31 level1 lfo32; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kaji toleransi aktifitas
misalnya<span style="mso-spacerun: yes;"> </span>keluhan kelemahan/ kelelahan
selama kerja atau tanda vital berubah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.0pt; mso-list: l23 level6 lfo11; tab-stops: list 18.0pt; text-indent: -17.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-bidi-font-weight: bold; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Verdana","sans-serif";">Intoleransi aktifitas dalam pemenuhan
kebutuhan sehari-hari </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Dapat dihubungakan dengan :
ketidakseimbangan antar suplai oksigen miocard dan<span style="mso-spacerun: yes;"> </span>kebutuhan, adanya iskemik/ nekrotik jaringan
miocard.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kemungkinan dibuktikan oeh :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Gangguan frekuensi jantung, tekanan
darah dalam aktifitas, terjadinya disritmia, kelemahan umum</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Terjadi peningkatan toleransi<span style="mso-spacerun: yes;"> </span>pada klien setelah dilaksanakan<span style="mso-spacerun: yes;"> </span>tindakan keperawatan selama di RS</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria :</span></i></b><span style="font-family: "Verdana","sans-serif";"> frekuensi jantung<span style="mso-spacerun: yes;"> </span>60-100 x/ menit dan TD 120-80 mmHg </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Rencana tindakan ::</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo33; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Catat frekuensi<span style="mso-spacerun: yes;"> </span>jantung, irama,<span style="mso-spacerun: yes;"> </span>dan perubahan TD selama dan sesudah aktifitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo33; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Tingkatkan istirahat ( di tempat
tidur )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo33; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Batasi aktifitas pada dasar
nyeri<span style="mso-spacerun: yes;"> </span>dan berikan aktifitas sensori yang
tidak berat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo33; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Jelaskan pola peningkatan<span style="mso-spacerun: yes;"> </span>bertahap dari tingkat aktifitas, contoh
bengun dari<span style="mso-spacerun: yes;"> </span>kursi bila tidak ada<span style="mso-spacerun: yes;"> </span>nyeri, ambulasi dan istirahat selam 1
jam<span style="mso-spacerun: yes;"> </span>setelah mkan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l0 level1 lfo33; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kaji ulang tanda<span style="mso-spacerun: yes;"> </span>gangguan yang menunjukan tidak toleran<span style="mso-spacerun: yes;"> </span>terhadap aktifitas atau memerlukan<span style="mso-spacerun: yes;"> </span>pelaporan pada dokter.</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 17.0pt; mso-list: l5 level1 lfo27; tab-stops: list 18.0pt; text-indent: -17.0pt;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-bidi-font-weight: bold; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Verdana","sans-serif";">Kurang pengetahuan mengenai kondisi,
kebutuhan pengobatan </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Dapat dihubungkan dengan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kurang<span style="mso-spacerun: yes;"> </span>informasi tentang fungsi jantung /
implikasi<span style="mso-spacerun: yes;"> </span>penyakit jantung<span style="mso-spacerun: yes;"> </span>dan status kesehatan<span style="mso-spacerun: yes;"> </span>yang akan datang , kebutuhan<span style="mso-spacerun: yes;"> </span>perubahan pol hidup.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: center 216.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kemungkinan dibuktikan oleh :<span style="mso-tab-count: 1;"> </span></span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Pernyataan masalah, kesalahan
konsep, pertanyaan, terjadinya kompliksi<span style="mso-spacerun: yes;">
</span>yang dapat dicegah</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Pengetahuan klien tentang<span style="mso-spacerun: yes;"> </span>kondisi<span style="mso-spacerun: yes;">
</span>penyakitnya<span style="mso-spacerun: yes;"> </span>menguat setelah
diberi<span style="mso-spacerun: yes;"> </span>pendidikan kesehatan selam di RS</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l8 level1 lfo34; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Menyatakan pemahaman tentang
penyakit jantung , rencana pengobatan,<span style="mso-spacerun: yes;">
</span>tujuan pengobatan & efek samping<span style="mso-spacerun: yes;">
</span>/ reaksi merugikan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l8 level1 lfo34; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Menyebutkan gngguan yang memerlukan
prhatian cepat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tindakan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l15 level1 lfo35; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Berikan informasi dalam bentuk
belajar yang berfariasi, contoh buku, program audio/ visual, Tanya jawab dll.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l15 level1 lfo35; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Beri penjelasan factor resiko, diet
( Rendah lemak dan rendah garam ) dan aktifitas yang berlebihan,</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l15 level1 lfo35; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Peringatan untuk menghindari
paktifitas manuver valsava</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l15 level1 lfo35; text-indent: -14.15pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ä<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Latih pasien sehubungan dengan
aktifitas yang bertahap contoh : jalan, kerja,<span style="mso-spacerun: yes;">
</span>rekreasi<span style="mso-spacerun: yes;"> </span>aktifitas seksual.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-indent: 4.5pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: list 18.0pt; text-indent: -36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; tab-stops: 378.0pt; text-align: justify;">
<br /></div>
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<br /></div>
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<span style="font-family: "Verdana","sans-serif";">TINJAUAN
TEORI CHF</span></h5>
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<h6 style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">DEFINISI</span></h6>
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<span style="font-family: "Verdana","sans-serif";">Gagal jantung kongestif adalah
ketidakmampuan jantung untuk memompa darah dalam jumlah yang cukup untuk
memenuhi kebutuhan jaringan terhadp oksigen dan nutrien. <i>(Diane C. Baughman
dan Jo Ann C. Hockley, 2000)</i></span></div>
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<span style="font-family: "Verdana","sans-serif";">Suatu keadaan<span style="mso-spacerun: yes;"> </span>patofisiologi<span style="mso-spacerun: yes;">
</span>adanya kelainan<span style="mso-spacerun: yes;"> </span>fungsi
jantung<span style="mso-spacerun: yes;"> </span>berakibat<span style="mso-spacerun: yes;"> </span>jantung gagal memompakan darah untuk memenuhi
kebutuhan<span style="mso-spacerun: yes;"> </span>metabolisme<span style="mso-spacerun: yes;"> </span>jaringan dan atau kemampuannya hanya ada
kalau<span style="mso-spacerun: yes;"> </span>disertai peninggian<span style="mso-spacerun: yes;"> </span>tekanan pengisian<span style="mso-spacerun: yes;"> </span>ventrikel kiri<span style="mso-spacerun: yes;"> </span><i>(Braundwald )</i></span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">ETIOLOGI</span></h6>
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<span style="font-family: "Verdana","sans-serif";">Gagal jantung kongestif
dapat disebabkan oleh :</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-style: italic; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i><span style="font-family: "Verdana","sans-serif";">Kelainan otot jantung</span></i></div>
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<span style="font-family: "Verdana","sans-serif";">Gagal
jantung sering terjadi pada penderita kelainan otot jantung, disebabkan
menurunnya kontraktilitas jantung.<span style="mso-spacerun: yes;">
</span>Kondisi yang mendasari penyebab kelainan fungsi otot mencakup
ateriosklerosis koroner, hiprtensi arterial, dan penyakit degeneratif atau
inflamasi.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Aterosklerosis
koroner mengakibatkan disfungsi miokardium karena terganggunya aliran darah ke
otot jantung.<span style="mso-spacerun: yes;"> </span>Terjadi hipoksia dan
asidosis (akibat penumpuikan asam laktat).<span style="mso-spacerun: yes;">
</span>Infark miokardium (kematian sel jantung) biasanya mendahului terjadinya
gagal jantung.<span style="mso-spacerun: yes;"> </span>Peradangan<span style="mso-spacerun: yes;"> </span>dan penyakit miokardium degeneratif,
berhubungan dengan gagal jantung karena kondisi yang secara langsung merusak
serabut jantung, menyebabkan kontraktilitaas menurun.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Hipertensi
sistemik atau pulmonal ( peningkatan afterload ) meningkatkan<span style="mso-spacerun: yes;"> </span>beban kerja jantung dan pada gilirannya<span style="mso-spacerun: yes;"> </span>mngakibatkan<span style="mso-spacerun: yes;">
</span>hipertrofi serabut otot jantung</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Peradangan
dan penyakit<span style="mso-spacerun: yes;"> </span>myocardium<span style="mso-spacerun: yes;"> </span>degeneratif, berhubungan dengan<span style="mso-spacerun: yes;"> </span>gagal jantung<span style="mso-spacerun: yes;">
</span>karena kondisi<span style="mso-spacerun: yes;"> </span>ini secara langsung<span style="mso-spacerun: yes;"> </span>merusak serabut jantung, menyebabkan
kontraktilitas menurun.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-style: italic; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i><span style="font-family: "Verdana","sans-serif";">Penyakit jantung lain</span></i></div>
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<span style="font-family: "Verdana","sans-serif";">Gagal
jantung dapat terjadi sebagai akibat penyakit jantung yang sebenarnya, yang
ssecara langsung mempengaruhi jantung.<span style="mso-spacerun: yes;">
</span>Mekanisme biasanya terlibat mencakup gangguan aliran darah yang masuk
jantung (stenosis katup semiluner), ketidak mampuan jantung untuk mengisi darah
(tamponade, perikardium, perikarditif konstriktif, atau stenosis AV),
peningkatan mendadak afteer load.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-style: italic; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i><span style="font-family: "Verdana","sans-serif";">Faktor sistemik</span></i></div>
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<span style="font-family: "Verdana","sans-serif";">Terdapat
sejumlah besar faktor yang berperan dalam perkembangan dan beratnya gagal
jantung.<span style="mso-spacerun: yes;"> </span>Meningkatnya laju
metabolisme(mis : demam, tirotoksikosis ), hipoksia dan anemia peperlukan
peningkatan curah jantung untuk memenuhi kebutuhan oksigen sistemik.<span style="mso-spacerun: yes;"> </span>Hipoksia dan anemia juga dapat menurunkan
suplai oksigen ke jantung.<span style="mso-spacerun: yes;"> </span>Asidosis
respiratorik atau metabolik dan abnormalita elekttronik dapat menurunkan
kontraktilitas jantung</span></div>
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<b><i><span style="font-family: "Verdana","sans-serif";">Grade
gagal jantung menurut New york Heart Associaion</span></i></b></div>
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<span style="font-family: "Verdana","sans-serif";">Terbagi
menjadi 4kelainan fungsional :</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>I.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Timbul
gejala sesak pada aktifitas fisik berat</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>II.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Timbul
gejala sesak pada aktifitas fisik sedang</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>III.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Timbul<span style="mso-spacerun: yes;"> </span>gejala sesak pada aktifitas ringan</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";">
</span>IV.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Timbul
gejala<span style="mso-spacerun: yes;"> </span>sesak pada aktifitas sangat
ringan/ istirahat</span></div>
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<b><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Verdana","sans-serif";">MANIFESTASI KLINIS</span></b></div>
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<b><span style="font-family: "Verdana","sans-serif";">Tanda
dominan :</span></b></div>
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<span style="font-family: "Verdana","sans-serif";">Meningkatnya
volume intravaskuler </span></div>
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<span style="font-family: "Verdana","sans-serif";">Kongestif
jaringan<span style="mso-spacerun: yes;"> </span>akibat tekanan arteri dan
vena<span style="mso-spacerun: yes;"> </span>meningkat akibat penurunan curah
jantungManifestasi kongesti dapat berbeda<span style="mso-spacerun: yes;">
</span>tergantung<span style="mso-spacerun: yes;"> </span>pada kegagalan
ventrikel mana yang terjadi .</span></div>
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<b><i><span style="font-family: "Verdana","sans-serif";">Gagal
jantung kiri :</span></i></b></div>
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<span style="font-family: "Verdana","sans-serif";">Kongesti
paru menonjol pada gagal ventrikel kiri krn ventrikel kiri tak mampu<span style="mso-spacerun: yes;"> </span>memompa darah yang datang dari paru.
Manifestasi klinis yang terjadi<span style="mso-spacerun: yes;"> </span>yaitu :</span></div>
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<span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Dispnu</span></div>
<div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 54.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Terjadi
akibat penimbunan cairan<span style="mso-spacerun: yes;"> </span>dalam alveoli
dan mengganggu pertukaran gas.Dapat terjadi ortopnu.Bebrapa pasien dapat
mengalami ortopnu pda malam hari yang dinamakan Paroksimal Nokturnal Dispnea (
PND) </span></div>
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<span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Batuk</span></div>
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<span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Mudah
lelah</span></div>
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<span style="font-family: "Verdana","sans-serif";">Terjadi
karena curah jantung yang kurang<span style="mso-spacerun: yes;"> </span>yang
menghambat<span style="mso-spacerun: yes;"> </span>jaringan<span style="mso-spacerun: yes;"> </span>dari sirkulasi normal dan oksigen serta
menurunnya<span style="mso-spacerun: yes;"> </span>pembuangan sisa<span style="mso-spacerun: yes;"> </span>hasil katabolismeJuga terjadi karena<span style="mso-spacerun: yes;"> </span>meningkatnya<span style="mso-spacerun: yes;">
</span>energi<span style="mso-spacerun: yes;"> </span>yang digunakan<span style="mso-spacerun: yes;"> </span>untuk bernafas dan insomnia yang terjadi
karena<span style="mso-spacerun: yes;"> </span>distress pernafasan dan batuk.</span></div>
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<span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kegelisahan
dan kecemasan</span></div>
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<span style="font-family: "Verdana","sans-serif";">Terjadi
akibat<span style="mso-spacerun: yes;"> </span>gangguan oksigenasi<span style="mso-spacerun: yes;"> </span>jaringan, stress akibat kesakitan<span style="mso-spacerun: yes;"> </span>bernafas dan pengetahuan bahwa jantung<span style="mso-spacerun: yes;"> </span>tidak berfungsi dengan baik.</span></div>
<div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 0cm; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";"><span style="mso-spacerun: yes;"> </span>G<i>agal jantung kanan</i></span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kongestif jaringan perifer dan
viseral.</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Edema ekstrimitas bawah (edema
dependen), biasanya edema pitting, penambahan berat badan, </span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Hepatomegali. Dan nyeri tekan<span style="mso-spacerun: yes;"> </span>pada kuadran<span style="mso-spacerun: yes;">
</span>kanan atas abdomen<span style="mso-spacerun: yes;"> </span>terjadi
akibat<span style="mso-spacerun: yes;"> </span>pembesaran<span style="mso-spacerun: yes;"> </span>vena di<span style="mso-spacerun: yes;">
</span>hepar…</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Anorexia dan mual. Terjadi
akibat<span style="mso-spacerun: yes;"> </span>pembesaran<span style="mso-spacerun: yes;"> </span>vena<span style="mso-spacerun: yes;">
</span>dan statis<span style="mso-spacerun: yes;"> </span>vena dalam rongga
abdomen.</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Nokturia </span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Kelemahan.</span></div>
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<br /></div>
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<b><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Verdana","sans-serif";">EVALUASI DIAGNOSTIK</span></b></div>
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<span style="font-family: "Verdana","sans-serif";">Meliputi
evaluasi manifestasi klinis dan pemantauan hemodinamik.</span></div>
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<b><i><span style="font-family: "Verdana","sans-serif";">Pengukuran
tekanan</span></i></b><span style="font-family: "Verdana","sans-serif";"> <b><i>preload,
afterload dan curah jantung</i></b> dapat diperoleh<span style="mso-spacerun: yes;"> </span>melalui lubang-lubang yang terl;etak<span style="mso-spacerun: yes;"> </span>pada<span style="mso-spacerun: yes;">
</span>berbagai interfal sepanjang kateter. <b><i>Pengukuran CVP ( N 15-20 mmhg
)</i></b> dapat menghasilkan pengukuran<span style="mso-spacerun: yes;">
</span>preload yang akurat .<b><i>PAWP atau pulmonary artery wedge pressure</i></b>
adalaah tekanan penyempitan arteri pulmonal dimana yang diukur adalah<span style="mso-spacerun: yes;"> </span>takanan akhir diastolic ventrikel kiri.</span></div>
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<b><i><span style="font-family: "Verdana","sans-serif";">Curah
Jantung</span></i></b><span style="font-family: "Verdana","sans-serif";"><span style="mso-spacerun: yes;"> </span>diukur dengan<span style="mso-spacerun: yes;">
</span>suatu lumen<span style="mso-spacerun: yes;"> </span>termodelusi yang
dihubungjkn dengan<span style="mso-spacerun: yes;"> </span>komputer</span></div>
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<b><span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Verdana","sans-serif";">PENATALAKSANAAN</span></b></div>
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<span style="font-family: "Verdana","sans-serif";">Tujuan
pengobatan adalah :</span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Dukung
istirahat<span style="mso-spacerun: yes;"> </span>untuk mengurangi<span style="mso-spacerun: yes;"> </span>beban kerja<span style="mso-spacerun: yes;">
</span>jantung. </span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Meningkatkan
kekuatan dan efisiensi kontraktilitas miokarium dengan preparat farmakologi,
dan </span></div>
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<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">Þ<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Membuang
penumpukan air tubuh yang berlebihan dengan cara memberikan terapi
antidiuretik, diit dan istirahat.</span></div>
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<b><i><span style="font-family: "Verdana","sans-serif";">Terapi
Farmakologis :</span></i></b></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Glikosida jantung.</span></div>
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<span style="font-family: "Verdana","sans-serif";">Digitalis ,
meningkatkan kekuatan kontraksi otot jantung dan memperlambat frekuensi
jantung.Efek yang dihasilkan : peningkatan curah jantung, penurunan tekanan
vena dan volume darah dan peningkatan diuresisidan mengurangi edema</span></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Terapi diuretik.</span></div>
<div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 70.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Diberikan
untuk memacu eksresi natrium<span style="mso-spacerun: yes;"> </span>dan air
mlalui ginjal.Penggunaan hrs hati – hati karena efek samping hiponatremia dan
hipokalemia</span></div>
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<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Terapi vasodilator.</span></div>
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<span style="font-family: "Verdana","sans-serif";">Obat-obat
fasoaktif digunakan untuk mengurangi<span style="mso-spacerun: yes;">
</span>impadansi tekanan<span style="mso-spacerun: yes;"> </span>terhadap<span style="mso-spacerun: yes;"> </span>penyemburan<span style="mso-spacerun: yes;">
</span>darah oleh ventrikel. Obat ini memperbaiki pengosongan ventrikel
dan<span style="mso-spacerun: yes;"> </span>peningkatan kapasitas vena
sehingga<span style="mso-spacerun: yes;"> </span>tekanan engisian<span style="mso-spacerun: yes;"> </span>ventrikel kiri<span style="mso-spacerun: yes;"> </span>dapat dituruinkan </span></div>
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<span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 1;"> </span><b><i>Dukungan diet:<span style="mso-tab-count: 2;"> </span></i></b></span></div>
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<span style="font-family: "Verdana","sans-serif";">Pembatasan
Natrium untuk mencegah, mengontrol, atau menghilangkan edema.</span></div>
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<br /></div>
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<br /></div>
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<b><span style="font-family: "Verdana","sans-serif";">PROSES
KEPERAWATAN</span></b></div>
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<b><span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 2;"> </span>Pengkajian</span></b></div>
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<span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 2;"> </span>Fokus
pengkajian keperawatan<span style="mso-spacerun: yes;"> </span>ditujukan<span style="mso-spacerun: yes;"> </span>untuk mngobservasi<span style="mso-spacerun: yes;"> </span>adanya<span style="mso-spacerun: yes;">
</span>tanda-tanda<span style="mso-spacerun: yes;"> </span>dan gejala
kelebihan<span style="mso-spacerun: yes;"> </span>ciaran paru dan tanda<span style="mso-spacerun: yes;"> </span>serta gejala sistemis.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Aktifitas
/istirahat</span></div>
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<span style="font-family: "Verdana","sans-serif";"><span style="mso-tab-count: 1;"> </span>Keletihan,
insomnia, nyeri dada dengan ktifitas, gelisah, dispnea saat istirahat atau
aktifitas, perubhan status mental, tanda vital berubah saat beraktifitas.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Sirkulasi</span></div>
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<span style="font-family: "Verdana","sans-serif";">Riwayat
HT IM akut, GJK sebelumnya, penyakit katup jantung,anemia , syok dll</span></div>
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<span style="font-family: "Verdana","sans-serif";">TD,
tekanan nadi frekuensi jantung,<span style="mso-spacerun: yes;"> </span>irama
jantung,<span style="mso-spacerun: yes;"> </span>nadi apical bunyu jantung<span style="mso-spacerun: yes;"> </span>S3 galop nadi perifer bekurang<span style="mso-spacerun: yes;"> </span>perubahan dalam denyutan<span style="mso-spacerun: yes;"> </span>nadi jugularis<span style="mso-spacerun: yes;"> </span>warna kulit kebiruan punggung kuku pucat atau
sianosis hepar adakag pembesaran<span style="mso-spacerun: yes;"> </span>bunyi
nafas krekles atau ronkhi edema.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Inegritas
ego</span></div>
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<span style="font-family: "Verdana","sans-serif";">Ansietas
stress marah taku<span style="mso-spacerun: yes;"> </span>dan mudah tersinggung</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Eliminasi</span></div>
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<span style="font-family: "Verdana","sans-serif";">Gejala
penurunan berkemih urun berwarna pekat,<span style="mso-spacerun: yes;">
</span>berkemih malam hario diare/ konsipasi.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Makanan
/ cairan</span></div>
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<span style="font-family: "Verdana","sans-serif";">Kehilangan
nafsu makan mual, muntah, penambahan Bbsignifikan, Pembengkakan ektrimitas
bawah,<span style="mso-spacerun: yes;"> </span>diit tinggi garam pengunaan
diuretic distensi abdomen edema umum dll.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Hygiene</span></div>
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<span style="font-family: "Verdana","sans-serif";">Keletihan
selama aktifitas perawatan diri, penampilan kurang </span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Neurosensori</span></div>
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<span style="font-family: "Verdana","sans-serif";">Kelemahan,
pusing letargi,<span style="mso-spacerun: yes;"> </span>perubahan perilaku
dan<span style="mso-spacerun: yes;"> </span>mudah tersinggung</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri/kenyamanan</span></div>
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<span style="font-family: "Verdana","sans-serif";">Nyeri
dada akut kronuk nyeri abdomen<span style="mso-spacerun: yes;"> </span>sakit
pada otot gelisah<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pernafasankeamanan</span></div>
<div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Dispnea
saat aktifitas tidur sambil duduk atau dngan beberapa bantal.btuk dengan atau
tanpa sputum penggunaan bantuan otot pernafasan oksigen dll. Bunyi nafas warna
kulit.</span></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Î<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Interaksi
socialPenurunan aktifitas yang biasa dilakukan</span></div>
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<br /></div>
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<span style="font-family: "Verdana","sans-serif";">Pemeriksaan
Diagnostik :</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">(a)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Foto torak dapat mengungkapkan
adanya pembesaran jantung, edema atau efusi pleura yang menegaskan diagnosa
CHF.</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">(b)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">EKG dapat mengungkapkan adanya
takhikardi, hipertropi bilik jantung dan iskemi (jika disebabkan oleh AMI).</span></div>
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<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">(c)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">Elektrolit serum yang mengungkapkan
kadar natrium yang rendah shg hasil hemodilusi darah dari adanya kelebihan
retensi air.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; text-align: justify;">
<br /></div>
<div class="MsoHeading8" style="line-height: 150%;">
<span style="font-family: "Verdana","sans-serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana;"><span style="mso-list: Ignore;">F.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Verdana","sans-serif";">DIAGNOSA KEPERAWATAN</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l24 level1 lfo16; tab-stops: list 27.0pt; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Verdana","sans-serif";">Penurunan perfusi jaringan
behubungan dngan menurunnya curah jantung , hipoksemia jaringan, asidosis, dan
kemungkinan thrombus atau emboli </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.65pt; text-align: justify;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kemungkinan
dibuktikan oleh :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Daerah
perifer dingin</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">EKG
elevasi segmen ST & Q patologis pada lead tertentu</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">RR
lebih dari 24 x/ menit</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kapiler
refill Lebih dari 3 detik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nyeri
dada</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Gambaran
foto torak terdpat pembesaran jantung & kongestif paru</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-indent: -9.0pt;">
<span style="font-family: "Verdana","sans-serif";"><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span>( tidak
selalu )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-indent: -9.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">HR
lebih dari 100 x/menit, TD > 120/80AGD dengan : pa O<sub>2</sub> < 80
mmHg, pa Co<sub>2</sub> > 45 mmHg dan Saturasi < 80 mmHg</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Nadi
lebih dari 100 x/ menit</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l23 level2 lfo11; tab-stops: list 36.0pt; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Terjadi
peningkatan enzim jantung yaitu CK, AST, LDL/HDL</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify;">
<b><i><span style="font-family: "Verdana","sans-serif";">Interfensi :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; tab-stops: 369.0pt;">
<span style="font-family: "Verdana","sans-serif";">Gangguan perfusi<span style="mso-spacerun: yes;"> </span>jaringan berkurang / tidak meluas selama
dilakukan tindakan perawatan di RS.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; tab-stops: 369.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; tab-stops: 369.0pt;">
<span style="font-family: "Verdana","sans-serif";">Daerah perifer hangat, tak sianosis,
gambaran EKG tak menunjukan perluasan infark RR 16-24 x/ menit tak terdapat
clubbing finger, kapiler refill 3-5 detik, nadi 60-100x / menit, TD 120/80 mmHg</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; tab-stops: 369.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Rencana Tindakan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo18; tab-stops: list 36.0pt left 54.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Monitor
Frekuensi dan irama jantung</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo18; tab-stops: list 36.0pt left 54.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Observasi
perubahan<span style="mso-spacerun: yes;"> </span>status mental</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo18; tab-stops: list 36.0pt left 54.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Observasi
warna<span style="mso-spacerun: yes;"> </span>dan suhu kulit / membran mukosa</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo18; tab-stops: list 36.0pt left 54.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Ukur
haluaran urin dan catat berat jenisnya</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo18; tab-stops: list 36.0pt left 54.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kolaborasi
: Berikan cairan IV l sesuai indikasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo18; tab-stops: list 36.0pt left 54.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pantau
Pemeriksaan diagnostik / dan laboratorium mis EKG, elektrolit , GDA( Pa O<sub>2</sub>,
Pa CO<sub>2</sub> dan saturasi O<sub>2 </sub>). Dan<span style="mso-spacerun: yes;"> </span>Pemberian oksigen</span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 54.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l23 level4 lfo11; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Verdana","sans-serif";">Kerusakan pertukarann gas </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Dapat dihubungkan oleh : </span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Gangguan aliran darah ke alveoli atau
kegagalan utama paru, perubahan membran<span style="mso-spacerun: yes;">
</span>alveolar- kapiler ( atelektasis , kolaps jalan nafas/ alveolar<span style="mso-spacerun: yes;"> </span>edema paru/efusi, sekresi berlebihan /
perdarahan aktif </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kemungkinan dibuktikan oleh :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Dispnea berat, gelisah, sianosis,
perubahan GDA, hipoksemia</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Oksigenasi dengan GDA dalam rentang
normal (pa O<sub>2</sub> < 80 mmHg, pa Co<sub>2</sub> > 45 mmHg dan
Saturasi < 80 mmHg ) setelah dilakukan tindakan keperawtan selama di RS.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria hasil :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Tidak sesak nafas,<span style="mso-spacerun: yes;"> </span>tidak gelisah,<span style="mso-spacerun: yes;"> </span>GDA dala batas Normal ( pa O<sub>2</sub> <
80 mmHg, pa Co<sub>2</sub> > 45 mmHg dan Saturasi < 80 mmHg )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tindakan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level5 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Catat
frekuensi & kedalaman pernafasan, penggunaan otot Bantu pernafasan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level5 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Auskultasi
paru untuk<span style="mso-spacerun: yes;"> </span>mengetahui penurunan / tidak
adanya<span style="mso-spacerun: yes;"> </span>bunyi nafas<span style="mso-spacerun: yes;"> </span>dan adanya bunyi tambahan missal krakles,
ronki dll.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level5 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Lakukan
tindakan untuk memperbaiki / mempertahankan jalan nafas misalnya , batuk,<span style="mso-spacerun: yes;"> </span>penghisapan lendir dll.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level5 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Tinggikan
kepala / tempat tidur sesuai kebutuhan / toleransi pasien</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level5 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kaji
toleransi aktifitas misalnya<span style="mso-spacerun: yes;"> </span>keluhan
kelemahan/ kelelahan selama kerja atau tanda vital berubah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo11; tab-stops: list 18.0pt; text-indent: -36.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Verdana","sans-serif";">Kemungkinan terhadap kelebihan<span style="mso-spacerun: yes;"> </span>volume cairan ekstravaskuler</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Faktor resiko meliputi :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Penurunan perfusi ginjal,
peningkatan<span style="mso-spacerun: yes;"> </span>natrium/ retensi air,
peningkatan<span style="mso-spacerun: yes;"> </span>tekanan hidrostatik atau
penurunan protein plasma ( menyerap cairan<span style="mso-spacerun: yes;">
</span>dalam area interstisial/ jaringan )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kemunkinan dibuktikan oleh : tidak
adanya tanda-tanda<span style="mso-spacerun: yes;"> </span>dan gejala gejala
membuat<span style="mso-spacerun: yes;"> </span>diagnosa actual.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Keseimbangan volume cairan dapat
dipertahankan<span style="mso-spacerun: yes;"> </span>selama dilakukan tindakan
keperawatan selama di RS</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Mempertahankan<span style="mso-spacerun: yes;"> </span>keseimbangan cairan seperti dibuktikan<span style="mso-spacerun: yes;"> </span>oleh tekanan darah dalam batas normal, tak
ada distensi<span style="mso-spacerun: yes;"> </span>vena perifer/ vena dan
edema<span style="mso-spacerun: yes;"> </span>dependen, paru bersih dan<span style="mso-spacerun: yes;"> </span>berat badan<span style="mso-spacerun: yes;">
</span>ideal ( BB idealTB –100 ± 10 %)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Perencanaan tindakan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level3 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Ukur
masukan / haluaran, catat penurunan , pengeluaran, sifat konsentrasi, hitung
keseimbangan cairan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level3 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Observasi
adanya oedema dependen</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level3 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Timbang
BB tiap hari</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level3 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pertahankan
masukan<span style="mso-spacerun: yes;"> </span>total caiaran 2000 ml/24 jam
dalam toleransi kardiovaskuler</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level3 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kolaborasi
: pemberian diet rendah natrium, berikan<span style="mso-spacerun: yes;">
</span>diuetik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level3 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kaji
JVP<span style="mso-spacerun: yes;"> </span>setelah terapi diuretic</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l23 level3 lfo11; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Pantau
CVP<span style="mso-spacerun: yes;"> </span>dan tekanan darah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l27 level1 lfo20; tab-stops: list 18.0pt; text-indent: -36.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Verdana","sans-serif";">Pola nafas tidak efektif </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<i><span style="font-family: "Verdana","sans-serif";">Yang berhubungan<span style="mso-spacerun: yes;"> </span>dengan</span></i><span style="font-family: "Verdana","sans-serif";"> :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Penurunan volume paru, hepatomegali,
splenomigali</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kemungkinan dibukikan oleh :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Perubahan kedalaman dan kecepatan
pernafasan ,gangguan<span style="mso-spacerun: yes;"> </span>pengembangan dada,
GDA tidak normal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Pola nafas efektif setelah dilakukan
tindakan keperawatan<span style="mso-spacerun: yes;"> </span>selam di RS, RR
Normal , tak ada bunyii nafas tambahan<span style="mso-spacerun: yes;">
</span>dan penggunaan otot Bantu pernafasan. Dan GDA Normal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Interfensi :</span></i></b></div>
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<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Monitor
kedalaman pernafasan, frekuensi, dan ekspansi dada.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l4 level1 lfo21; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Catat
upaya pernafasan<span style="mso-spacerun: yes;"> </span>termasuk penggunaan
otot Bantu nafas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l4 level1 lfo21; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Auskultasi
bunyi nafas dan catat bila ada bunyi nafas tambahan </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l4 level1 lfo21; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Tinggikan
kepala<span style="mso-spacerun: yes;"> </span>dan<span style="mso-spacerun: yes;"> </span>Bantu untuk mencapi posisi yang senyaman
mungkin.Kolaborasi pemberian Oksigen<span style="mso-spacerun: yes;"> </span>dan
px GDA</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo11; tab-stops: list 18.0pt; text-indent: -36.0pt;">
<span style="font-family: Wingdings; font-size: 8.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Verdana","sans-serif";">Intoleransi aktifitas dalam
pemenuhan kebutuhan sehari-hari </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Dapat dihubungakan dengan :
ketidakseimbangan antar suplai oksigen miocard dan<span style="mso-spacerun: yes;"> </span>kebutuhan, adanya iskemik/ nekrotik jaringan
miocard.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Kemungkinan dibuktikan oeh :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Gangguan frekuensi jantung, tekanan
darah dalam aktifitas, terjadinya disritmia, kelemahan umum</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Tujuan :</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<span style="font-family: "Verdana","sans-serif";">Terjadi peningkatan toleransi<span style="mso-spacerun: yes;"> </span>pada klien setelah dilaksanakan<span style="mso-spacerun: yes;"> </span>tindakan keperawatan selama di RS</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Kriteria :</span></i></b><span style="font-family: "Verdana","sans-serif";"> frekuensi jantung<span style="mso-spacerun: yes;"> </span>60-100 x/ menit dan TD 120-80 mmHg </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<b><i><span style="font-family: "Verdana","sans-serif";">Rencana tindakan ::</span></i></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l14 level1 lfo12; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Catat
frekuensi<span style="mso-spacerun: yes;"> </span>jantung, irama,<span style="mso-spacerun: yes;"> </span>dan perubahan TD selama dan sesudah aktifitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l14 level1 lfo12; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Tingkatkan
istirahat ( di tempat tidur )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l14 level1 lfo12; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Batasi
aktifitas pada dasar nyeri<span style="mso-spacerun: yes;"> </span>dan berikan
aktifitas sensori yang tidak berat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l14 level1 lfo12; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Jelaskan
pola peningkatan<span style="mso-spacerun: yes;"> </span>bertahap dari tingkat
aktifitas, contoh bengun dari<span style="mso-spacerun: yes;"> </span>kursi bila
tidak ada<span style="mso-spacerun: yes;"> </span>nyeri, ambulasi dan istirahat
selam 1 jam<span style="mso-spacerun: yes;"> </span>setelah mkan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; mso-list: l14 level1 lfo12; tab-stops: list 45.0pt; text-indent: -27.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Verdana","sans-serif";">Kaji
ulang tanda<span style="mso-spacerun: yes;"> </span>gangguan yang menunjukan
tidak toleran<span style="mso-spacerun: yes;"> </span>terhadap aktifitas atau
memerlukan<span style="mso-spacerun: yes;"> </span>pelaporan pada dokter.</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: list 36.0pt left 54.0pt; text-indent: -27.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; tab-stops: 369.0pt; text-align: justify;">
<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
<h5 style="line-height: 150%;">
<span style="font-family: "Verdana","sans-serif";">DAFTAR
PUSTAKA</span></h5>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 45.0pt; text-align: justify; text-indent: -45.0pt;">
<span style="font-family: "Verdana","sans-serif";">Brunner
& Suddarth, <b><i>Buku Ajar Keperawatan Mdikal Bedah, edisi 8</i></b>,<span style="mso-spacerun: yes;"> </span>1997,<span style="mso-spacerun: yes;">
</span>EGC, Jakarta.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Verdana","sans-serif";">Doenges
E. Marlynn, <b><i>Rencana Asuhan Keperawatan</i></b> , 2000, EGC, Jakarta.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Gallo & Hudak, <b><i>Keperawatan
Kritis, edisi VI</i></b>, 1997, EGC Jakarta</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Verdana","sans-serif";">Noer
Staffoeloh et all, <b><i>Buku Ajar Ilmu Penyakit Dalam Jilid I</i></b>, 1999,
Balai Penerbit FKUI, Jakarta</span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: "Verdana","sans-serif";">Nursalam.
M.Nurs, <b><i>Managemen Keperawatan : Aplikasi dalam Praktek Keperawatan
Profesional</i></b>, 2002, Salemba Medika, Jakarta</span></div>
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<br /></div>
<div class="MsoBodyText3" style="line-height: 150%; tab-stops: 36.0pt;">
<span style="font-family: "Verdana","sans-serif";">Russel C Swanburg, <b><i>Pengantar
keparawatan</i></b>, 2000, EGC, Jakarta.</span></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoTitle">
<span style="font-family: "Verdana","sans-serif";">BAB I</span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b><span style="font-family: "Verdana","sans-serif";">PENDAHULUAN</span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<h1 style="line-height: 150%;">
<span style="font-family: "Verdana","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 16.0pt;">LATAR BELAKANG</span></h1>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.65pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Penyakit jantung
merupakan salah satu penyebab morbiditas & mortalitas. Akhir-akhir ini
insiden penyakit jantung<span style="mso-spacerun: yes;"> </span>mengalami
peningkatan. Kajian epidemiologi menunjukan<span style="mso-spacerun: yes;">
</span>bahwa ada berbagai kondisi<span style="mso-spacerun: yes;"> </span>yang
mendahului dan menyertai<span style="mso-spacerun: yes;"> </span>penyakit
jantung. Kondisi tersebut dinamakan factor resiko. Faktor resiko yang ada<span style="mso-spacerun: yes;"> </span>dapat dimodifikasi<span style="mso-spacerun: yes;"> </span>artinya<span style="mso-spacerun: yes;">
</span>dapat dikontrol dengan<span style="mso-spacerun: yes;"> </span>mengubah
gaya hidup<span style="mso-spacerun: yes;"> </span>atau kebiasaan<span style="mso-spacerun: yes;"> </span>pribadi<span style="mso-spacerun: yes;">
</span>dan factor resiko<span style="mso-spacerun: yes;"> </span>yang<span style="mso-spacerun: yes;"> </span>non modifiable yang merupakan konsekwensi
genetic yang tak dapat dikontrol. Contohnya ras, dan jenis kelamin. Penyakit
koroner<span style="mso-spacerun: yes;"> </span>“ Serangan Jantung “ atau lebih
kita kenal dengan infark miokard adalah istilah yang sama. Gejala ini<span style="mso-spacerun: yes;"> </span>akibat adanya kerusakan ireversibelsel
jantung. Kerusakan ini<span style="mso-spacerun: yes;"> </span>akan
mengalami<span style="mso-spacerun: yes;"> </span>degenerasi dan akhirnya
menimbulkan jaringan parur. Bila kerusakan ini<span style="mso-spacerun: yes;">
</span>meluas akhirnya jantung mengalami kegagalan pemompaan<span style="mso-spacerun: yes;"> </span>darah sehingga<span style="mso-spacerun: yes;"> </span>tidak mampu memenuhi<span style="mso-spacerun: yes;"> </span>kebutuhan tubuh akan darah<span style="mso-spacerun: yes;"> </span>sehingga<span style="mso-spacerun: yes;">
</span>curah jantung tidak adekuat. Keadaan ini<span style="mso-spacerun: yes;">
</span>kita kenal dengan gagal jantung. Penyebab GGK masih banyak yang akan
kita<span style="mso-spacerun: yes;"> </span>bicarakan pada makalah ini.</span></div>
<h1 style="line-height: 150%;">
<span style="font-family: "Verdana","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 16.0pt;">TUJUAN</span></h1>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify;">
<span style="font-family: "Verdana","sans-serif";">Dalam penulisan makalah
ini diharapkan mahasiswa mampu :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: "Verdana","sans-serif";">Memahami<span style="mso-spacerun: yes;">
</span>pengertian, etiologi, manifestasi klinik,<span style="mso-spacerun: yes;"> </span>dan pemeriksaan diagnostik<span style="mso-spacerun: yes;"> </span>AMI & CHF</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -27.0pt;">
<span style="font-family: "Verdana","sans-serif";">Menerapkan prinsip asuhan keperawatan<span style="mso-spacerun: yes;"> </span>dengan pendekatan proses keperawatan<span style="mso-spacerun: yes;"> </span>meliputi pengkajian, diagnosa keperawatan ,
rencana tindakan , implementasi dan efaluasi pada kasus AMI & CHF.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; text-align: justify;">
<br /></div>
<h1 style="line-height: 150%;">
<span style="font-family: "Verdana","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-size: 16.0pt;">RUANG LINGKUP</span></h1>
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<span style="font-family: "Verdana","sans-serif";">Etiologi, pathofisiologi, manifestasi klinis &
pemeriksaan diagnostik AMI & CHF.</span></div>
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<span style="font-family: "Verdana","sans-serif";">Pengkajian keperawatan secara komperhensif pada kasus
AMI & CHF.</span></div>
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<span style="font-family: "Verdana","sans-serif";">Diagnosa Keperawatan<span style="mso-spacerun: yes;">
</span>yang lazim terjadi pada kasus AMI & CHF.</span></div>
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<span style="font-family: "Verdana","sans-serif";">Intervensi Keperawatan<span style="mso-tab-count: 1;"> </span></span></div>
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<span style="font-family: "Verdana","sans-serif";">Evaluasi</span></div>
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<br /></div>
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<br /></div>
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<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-79162417682706661832011-11-10T06:55:00.001-08:002011-11-10T06:57:25.971-08:00BGA<!--[if gte mso 9]><xml>
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<span style="font-weight: normal;">Petunjuk Pengambilan sampel </span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><i><u><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">dan analisa
hasil pemeriksaan Gas darah</span></u></i></b><i><u><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"> </span></u></i></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Pengambilan sampel :</span></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Persiapan Alat :</span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Disposibel
2, 5 CC</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Botol Infus</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Betadine</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Kapas </span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Karet
penutup</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Heparin
Cair</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Blanko
Pemeriksaan</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Duk
Pengalas</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Petunjuk Pengambilan :</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Lokasi
pengambilan sampel :</span></div>
<h1>
<span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span>Arteri Radialis, Brachialis, Inguinalis dan Dorsalis
pedis</h1>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Darah Yang
diambil 2 cc ditambah 1 Strip</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Yang harus
diisi dalam blanko pemeriksaan : Identitas pasien, Suhu tubuh pasien, Hb
terakhir dan kalau pasien menggunakan oksigen catat jumlah O2 yang digunakan
serta cara pemberiannya dan Jenis permintaan.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">dddddd</span></div>
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<br /></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Tekhnik Pengambilan :</span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Bentangkan
duk pengalas.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Letakkan
botol infus</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Tangan
pasien diletakkan diatas botol infus, dengan sendi melipat kebelakang.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Sedot
heparin cair sebanyak 1 cc dan kmudian keluarkan. Heparin hanya membasahi
dinding disposible. Tidak ada sisa o,1 cc dalam disposible, kecuali yang ada
didalam jarum.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Raba Nadi
dengan menggunakan jari telunjuk dan jari tengah.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Pastikan
tempat dari nadi yang diraba.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Desinfeksi
daerah tersebut</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Desinfeksi
kedua jari</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Pegang
disposible seperti memegang pensil.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Raba kembali Nadi dengan menggunakan kedua yang telah
didesinfeksi</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">11.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Tusukan jarum diantara kedsua jari dengan sudut 45
drajat mengarah ke jantung.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Biarkan Darah sendiiri mengalir ke dalam jarum. Jangan
diaspirasi.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">13.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Cabut jarum dan tusukkan pada karet penutup.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">14.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Tekan daerah penusukan dengan menggunakan kapas
betadine selama 5 menit.</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l4 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">15.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Beri etiket dan bawa ke laboraotirum.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Interprestasi hasil :</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo4; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Yang
terutama diperhatikan adalah :</span></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l1 level1 lfo5; tab-stops: list 81.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Ph Darah<span style="mso-tab-count: 1;"> </span>: 7,35 – 7,45</span></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l1 level1 lfo5; tab-stops: list 81.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Pco2<span style="mso-tab-count: 1;"> </span>: 35 - 45<span style="mso-tab-count: 1;"> </span></span></div>
<div class="MsoNormal" style="margin-left: 81.0pt; mso-list: l1 level1 lfo5; tab-stops: list 81.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">BE<span style="mso-tab-count: 2;"> </span>: -3<span style="mso-spacerun: yes;">
</span>- +3</span></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo4; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Lain – Lain
sebagai tambahan :</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">PO2<span style="mso-tab-count: 2;"> </span>: 80 – 104 mmHg</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Saturasi<span style="mso-tab-count: 1;"> </span>: Saturasi 97 – 98 %</span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">BB<span style="mso-tab-count: 2;"> </span>: </span></div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l0 level2 lfo4; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Hco3 <sup>-<span style="mso-tab-count: 1;"> </span>: </sup><span style="mso-spacerun: yes;"> </span>21 - 25</span></div>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Cara Interprestasi :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Ph :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="mso-ignore: vglayout;">
</span></div>
<table align="left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td height="1" width="82"><br /></td>
<td width="195"><br /></td>
<td width="58"><br /></td>
<td width="171"><br /></td>
</tr>
<tr>
<td height="12"><br /></td>
<td align="left" valign="top"><img height="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="195" /></td>
<td><br /></td>
<td align="left" valign="top"><img height="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="171" /></td>
</tr>
</tbody></table>
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"> </span><br />
<br clear="ALL" style="mso-ignore: vglayout;" />
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>(acidosis)<span style="mso-spacerun: yes;"> </span>Asam<span style="mso-spacerun: yes;"> </span>7,35<span style="mso-spacerun: yes;">
</span>-<span style="mso-spacerun: yes;"> </span>7,45<span style="mso-spacerun: yes;"> </span>Basa<span style="mso-spacerun: yes;">
</span>(Alkalosis)</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">PcO2</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="mso-ignore: vglayout; position: relative; z-index: 251657216;"><span style="height: 12px; left: 0px; left: 82px; position: absolute; top: -1px; width: 424px;">
</span></span></div>
<table align="left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td height="0" width="0"><br /></td>
<td width="171"><br /></td>
<td width="70"><br /></td>
<td width="183"><br /></td>
</tr>
<tr>
<td height="12"><br /></td>
<td align="left" valign="top"><img height="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="171" /></td>
<td><br /></td>
<td align="left" valign="top"><img height="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="183" /></td>
</tr>
</tbody></table>
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"> </span><br />
<br clear="ALL" style="mso-ignore: vglayout;" />
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>(Alkalosis) Basa<span style="mso-spacerun: yes;"> </span>35<span style="mso-spacerun: yes;">
</span>-<span style="mso-spacerun: yes;"> </span>4<span style="mso-spacerun: yes;"> </span>Asam<span style="mso-spacerun: yes;">
</span>(Acidosis)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-spacerun: yes;">
</span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">BE<span style="mso-spacerun: yes;">
</span></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="mso-ignore: vglayout; position: relative; z-index: 251659264;"><span style="height: 12px; left: 0px; left: 46px; position: absolute; top: -3px; width: 472px;">
</span></span></div>
<table align="left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td height="0" width="0"><br /></td>
<td width="183"><br /></td>
<td width="82"><br /></td>
<td width="207"><br /></td>
</tr>
<tr>
<td height="12"><br /></td>
<td align="left" valign="top"><img height="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="183" /></td>
<td><br /></td>
<td align="left" valign="top"><img height="12" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image006.gif" width="207" /></td>
</tr>
</tbody></table>
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"> </span><br />
<br clear="ALL" style="mso-ignore: vglayout;" />
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>(Acidosis)<span style="mso-spacerun: yes;"> </span>Asam<span style="mso-spacerun: yes;">
</span>-3<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;"> </span>+3<span style="mso-spacerun: yes;">
</span>Basa<span style="mso-spacerun: yes;"> </span>(Alkalosis)</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Pco2 Menentukan : Respiratorik</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">BE<span style="mso-spacerun: yes;">
</span>Menentukkan : Metabolik</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Contoh :</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Hasil Pemeriksaan : Ph 7,20</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Pco2<span style="mso-spacerun: yes;"> </span>: 50</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">BE<span style="mso-spacerun: yes;"> </span>: -2</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Berarti pasien mengalami : Acidosis
respiratorik</span></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-18994713752534283272011-11-10T06:54:00.001-08:002011-11-10T06:54:53.839-08:00Akep CVP<!--[if gte mso 9]><xml>
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<div class="MsoTitle">
ASUHAN<span style="mso-spacerun: yes;"> </span>KEPERAWATAN </div>
<div class="MsoTitle">
PADA<span style="mso-spacerun: yes;"> </span>PASIEN<span style="mso-spacerun: yes;"> </span>DENGAN<span style="mso-spacerun: yes;">
</span>PEMASANGAN<span style="mso-spacerun: yes;"> </span>CVP</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoSubtitle" style="margin-left: 36.0pt; mso-list: l7 level1 lfo1; tab-stops: list 36.0pt; text-indent: -36.0pt;">
<span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengertian</div>
<div class="MsoNormal">
Tekanan vena central (central venous pressure) adalah
tekanan darah di AKa atau vena kava. Ini memberikan informasi tentang tiga
parameter volume darah, keefektifan jantung sebagai pompa, dan tonus vaskular.
Tekanan vena central dibedakan dari tekanan vena perifer, yang dapat
merefleksikan hanya tekanan lokal.</div>
<div class="MsoNormal">
<br /></div>
<h1>
<span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span>Lokasi Pemantauan</h1>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo5; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Vena Jugularis interna kanan atau kiri (lebih
umum pada kanan)</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo5; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Vena subklavia kanan atau kiri, tetapi duktus toraks
rendah pada kanan</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo5; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Vena brakialis, yang mungkin tertekuk dan
berkembang menjadi phlebitis</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo5; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Lumen proksimal kateter arteri pulmonalis, di
atrium kanan atau tepat di atas vena kava superior</div>
<div class="MsoNormal">
<br /></div>
<h1>
<span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";"> </span></span>Indikasi<span style="mso-spacerun: yes;"> </span>dan<span style="mso-spacerun: yes;">
</span>Penggunaan</h1>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pengukuran tekanan vena sentral (CVP).</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pengambilan darah untuk pemeriksaan
laboratorium.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pengukuran oksigenasi vena sentral.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nutrisi parenteral dan pemberian cairan
hipertonik atau cairan yang mengiritasi yang perlu pengenceran segera dalam
sistem sirkulasi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pemberian obat vasoaktif per drip (tetesan) dan
obat inotropik.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Sebagai jalan masuk vena bila semua tempat IV
lainnya telah lemah.</div>
<div class="MsoNormal">
<br /></div>
<h1 style="margin-left: 0cm; mso-list: none; tab-stops: 21.85pt; text-indent: 0cm;">
III.<span style="mso-tab-count: 1;"> </span>Komplikasi</h1>
<div class="MsoNormal">
Adapun komplikasi dari pemasangan kanulasi CVP antara lain :</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri dan inflamasi pada lokasi penusukan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bekuan darah karena tertekuknya kateter.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Perdarahan : ekimosis atau perdarahan besar bila
jarum terlepas.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tromboplebitis (emboli thrombus,emboli udara,
sepsis).</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Microshock.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Disritmia jantung</div>
<div class="MsoNormal">
<br /></div>
<h1>
<span style="mso-list: Ignore;">III.<span style="font: 7.0pt "Times New Roman";"> </span></span>Pengkajian</h1>
<div class="MsoNormal">
Yang perlu dikaji pada pasien yang terpasang CVP adalah
tanda-tanda komplikasi yang ditimbulkan oleh pemasangan alat.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Keluhan nyeri, napas sesak, rasa tidak nyaman.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Keluhan verbal adanya kelelahan atau kelemahan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Frekuensi napas, suara napas</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tanda kemerahan / pus pada lokasi pemasangan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Adanya gumpalan darah / gelembung udara pada
cateter</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kesesuaian posisi jalur infus set</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tanda-tanda vital, perfusi</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tekanan CVP</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Intake dan out put</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>ECG Monitor</div>
<div class="MsoNormal">
<br /></div>
<h1>
<span style="mso-list: Ignore;">IV.<span style="font: 7.0pt "Times New Roman";"> </span></span>Diagnosa
Keperawatan</h1>
<h3>
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan aktivitas berhubungan dengan<span style="mso-spacerun: yes;"> </span>pemasangan kateter vena central </h3>
<div class="MsoNormal">
Kriteria pengkajian<span style="mso-spacerun: yes;">
</span>focus :</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l3 level1 lfo2; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kelemahan, kelelahan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l3 level1 lfo2; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Perubahan tanda vital, adanya disritmia.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l3 level1 lfo2; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dispnea.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l3 level1 lfo2; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pucat</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l3 level1 lfo2; tab-stops: list 54.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berkeringat.</div>
<div class="MsoNormal">
<br /></div>
<h1>
<span style="mso-list: Ignore;">V.<span style="font: 7.0pt "Times New Roman";"> </span></span>Tujuan
Asuhan Keperawatan</h1>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"> </span>Pasien akan mencapai
peningkatan toleransi aktivitas yang dapat diukur, dibuktikan oleh menurunnya
kelemahan dan kelelahan dan tanda vital DBN selama aktivitas.</div>
<div class="MsoNormal" style="margin-left: 42.55pt; text-indent: -42.55pt;">
<br /></div>
<h1>
<span style="mso-list: Ignore;">VI.<span style="font: 7.0pt "Times New Roman";"> </span></span>Intervensi
</h1>
<div class="MsoNormal" style="margin-left: 17.85pt; mso-list: l9 level1 lfo6; tab-stops: list 18.0pt left 21.3pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: bold;">Periksa tanda vital sebelum dan segera
setelah aktivitas.</span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; tab-stops: 21.3pt;">
Rasionalisasi :
Hipotensi ortostatik dapat terjadi dengan aktivitas.</div>
<div class="MsoNormal" style="margin-left: 17.85pt; mso-list: l9 level1 lfo6; tab-stops: list 18.0pt left 21.3pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Catat respons kardiopulmonal terhadap aktivitas,
catat takikardi, disritmia, dispnea, berkeringat, pucat.</div>
<div class="MsoNormal" style="margin-left: 17.85pt; tab-stops: 21.3pt;">
Rasionalisasi :
penurunan/ketidakmampuan miokardium untuk meningkatkan volume sekuncup selama
aktivitas, dapat menyebabkan peningkatan segera pada frekuensi jantung dan
kebutuhan oksigen, juga peningkatan kelelahan dan kelemahan.</div>
<div class="MsoNormal" style="margin-left: 17.85pt; mso-list: l2 level1 lfo7; tab-stops: list 18.0pt left 21.3pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kaji presipitator/penyebab kelemahan contoh nyeri.
</div>
<div class="MsoNormal" style="margin-left: 17.85pt;">
Rasionalisasi : Nyeri dan
program penuh stres jugas memerlukan energi dan menyebabkan kelemahan.</div>
<div class="MsoNormal" style="margin-left: 17.85pt; mso-list: l4 level1 lfo8; tab-stops: list 18.0pt left 21.3pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Anjurkan latihan ROM aktif atau bila pasien
tidak dapat memenuhinya lakukan ROM pasif setiap 6 jam.</div>
<div class="MsoNormal" style="margin-left: 17.85pt;">
Rasionalisasi : ROM dapat
meningkatkan kekuatan otot, memperbaiki sirkulasi dan mengurangi rasa tidak
nyaman.</div>
<div class="MsoNormal" style="margin-left: 17.85pt; mso-list: l11 level1 lfo9; tab-stops: list 18.0pt left 21.3pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Jelaskan bahwa gangguan aktivitas adalah kondisi
sementara yang diharuskan hanya selama waktu pemantauan sementara.</div>
<div class="MsoNormal" style="margin-left: 17.85pt;">
Rasionalisasi : Penjelasan dapat
mengurangi anxietas karena rasa takut terhadap pemasangan<span style="mso-spacerun: yes;"> </span>CVP.</div>
<div class="MsoNormal" style="margin-left: 17.85pt; mso-list: l0 level1 lfo10; tab-stops: list 18.0pt left 21.3pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan bantuan dalam aktivitas perawatan diri
sesuai indikasi.</div>
<div class="MsoNormal" style="margin-left: 17.85pt; mso-list: l0 level1 lfo10; tab-stops: list 18.0pt left 21.3pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Rasionalisasi : Pemenuhan kebutuhan perawatan
diri pasien tanpa mempengaruhi pemasangan CVP.</div>
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; text-transform: uppercase;"><br clear="all" style="page-break-before: always;" />
</span></b>
<div class="MsoTitle">
DAFTER PUSTAKA</div>
<div class="MsoTitle">
<br /></div>
<div class="MsoNormal">
Anna Owen, 1997. <i style="mso-bidi-font-style: normal;">Pemantauan
Perawatan Kritis</i>. EGC. Jakarta.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Carpenito, Lynda Juall, 2000. <i style="mso-bidi-font-style: normal;">Diagnosa Keperawatan</i> .EGC. Jakarta.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Doenges M.E.<span style="mso-spacerun: yes;"> </span>at all,
1993. <i style="mso-bidi-font-style: normal;">Rencana Asuhan Keperwatan</i>.
Edisi 3. EGC. Jakarta</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Hudak & Gallo, 1997. <i style="mso-bidi-font-style: normal;">Keperawatan
Kritis Edisi VI Volume I</i>. EGC. Jakarta.</div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-80542566933022453972011-11-10T06:50:00.001-08:002011-11-10T06:50:37.171-08:00RJP (resusitasi Jantung Paru)<!--[if gte mso 9]><xml>
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<div class="MsoTitle">
RESUSITASI JANTUNG PARU</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Pengertian:</b></div>
<div class="MsoNormal">
RJP adalah usaha –usaha yang dapat dilakukan untuk mencegah
sesuatu episode henti jantung berlanjut menjadi kematian biologis.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Indikasi :</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Keadaan
henti napas.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Keadaan
henti jantung</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Kontra indikasi:</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo2; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Terminal
illnes</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo2; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Mati
secara klinis > 5 menit</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Prosedur:</b></div>
<div class="MsoNormal">
<span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-no-proof: yes; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span> algoritma ACLS</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Nursing Management</b></div>
<div class="MsoNormal">
During Resusitation:</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Orang
pertama yang menemukan penderita <span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-no-proof: yes; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span>-<span style="mso-tab-count: 1;"> </span>memulai CPR</div>
<div class="MsoNormal" style="margin-left: 252.0pt;">
-<span style="mso-tab-count: 1;"> </span>meminta pertolongan</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Melanjutkan
CPR</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Monitoring:
irama jantung, tanda vital, defibrilasi, pemberian obat-obatan, mencatat
kejadian mengontrol lingkungan, calling dokter dan keluarga.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo3; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Support
keluarga</div>
<div class="MsoNormal">
Post Arrest Management:</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span>EKG
:</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Memonitor irama cardiac.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span>Pemberian
Oksigen:</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Melalui nasal kanula, face mask,
atau ventilasi mekanik.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span>Pastikan
kepatenan IV line.</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Pemberian therapi : antiaritmia,
morphin, atrophin, dll.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span>Temukan
Penyebab arrest, jika memungkinkan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span>Lanjutkanpengkajian
hemodinamik.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span>EKG
12 lead.:</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Untuk menentukan :</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>ada infark baru ? meluas ?.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>disritmia</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span>Nilai
laboratorium:</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>CK –MB</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Analisa gas darah : keseimbangan asam basa : oksigenasi</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l8 level1 lfo4; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span>Chest
– X-ray</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Evaluasi posisi alat : ETT,
cateter didalam tubuh.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Diagnosa Keperawatan:</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l6 level1 lfo6; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span>menurunnya
kardiac output b.d gangguan fungsi mekanik dan / elektrik jantung</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Tujuan: </div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Pasien memiliki cardiag output
yang adekuat ditandai dengan :</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Respon terhadap stimulus.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Pulsasi teraba.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>B.P systolik _ 90 mmHg</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Perencanaan / pelaksanaan:</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
( Algoritma ACLS)</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<h3>
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>LOKASI KOMPRESI</h3>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
X : 2 – 3 jari
diatas<span style="mso-spacerun: yes;"> </span>procescus sipoideus</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<h3>
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>POSISI WAKTU KOMPRESI</h3>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Ket:</div>
<div class="MsoNormal" style="margin-left: 21.6pt; mso-list: l5 level1 lfo7; tab-stops: list 21.6pt; text-indent: -21.6pt;">
<span style="font-family: "Monotype Sorts"; mso-bidi-font-family: "Monotype Sorts"; mso-fareast-font-family: "Monotype Sorts";"><span style="mso-list: Ignore;">Û<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Head tilt chin lift : tengadah kepada topang
dagu.</div>
<div class="MsoNormal" style="margin-left: 21.6pt; mso-list: l5 level1 lfo7; tab-stops: list 21.6pt; text-indent: -21.6pt;">
<span style="font-family: "Monotype Sorts"; mso-bidi-font-family: "Monotype Sorts"; mso-fareast-font-family: "Monotype Sorts";"><span style="mso-list: Ignore;">Û<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Jaw Thrust : Dorong mandibula ke depan dan
keatas.</div>
<div class="MsoNormal" style="margin-left: 21.6pt; mso-list: l5 level1 lfo7; tab-stops: list 21.6pt; text-indent: -21.6pt;">
<span style="font-family: "Monotype Sorts"; mso-bidi-font-family: "Monotype Sorts"; mso-fareast-font-family: "Monotype Sorts";"><span style="mso-list: Ignore;">Û<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tripple Manufer : perasat 3 cara</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>ekstensi kepala.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Dorong mandibula ke atas dan ke depan.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Buka mulut</div>
<h4>
<span style="mso-list: Ignore;">a)<span style="font: 7.0pt "Times New Roman";">
</span></span>MEMBUKA JALAN NAPAS</h4>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
Head
Tilt Chin Lift</div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<h4>
<span style="mso-list: Ignore;">b)<span style="font: 7.0pt "Times New Roman";">
</span></span>MENILAI PERNAPASAN</h4>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-left: 18.0pt; text-align: center;">
<br /></div>
<h4>
<span style="mso-list: Ignore;">c)<span style="font: 7.0pt "Times New Roman";">
</span></span>MEMBERIKAN NAPAS BUATAN</h4>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">PROSEDUR B.H.D (B.L.S.)</span></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">MENILAI KESADARAN</b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">MINTA PERTOLONGAN</b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;">MEMPERBAIKI POSISI PENDERITA</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
JIKA RESUSITASI GAGAL <span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-no-proof: yes; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span>
MATI</div>
<div class="MsoNormal" style="margin-left: 21.6pt; mso-list: l3 level1 lfo8; tab-stops: list 21.6pt; text-indent: -21.6pt;">
<span style="font-family: "Monotype Sorts"; mso-bidi-font-family: "Monotype Sorts"; mso-fareast-font-family: "Monotype Sorts";"><span style="mso-list: Ignore;">Û<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dokter dan perawat memberi penjelasan pada
keluarga</div>
<div class="MsoNormal" style="margin-left: 21.6pt; mso-list: l3 level1 lfo8; tab-stops: list 21.6pt; text-indent: -21.6pt;">
<span style="font-family: "Monotype Sorts"; mso-bidi-font-family: "Monotype Sorts"; mso-fareast-font-family: "Monotype Sorts";"><span style="mso-list: Ignore;">Û<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mempersiapkan jenazah:</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>membersihkan dari alat yang telah digunakan dan
ruangan.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Membersihkan jasad</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
POST ARREST MANAGEMENT:</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: Wingdings; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-no-proof: yes; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span>
Bila CPR berhasil</div>
<div class="MsoNormal">
<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-64586679359967685452011-11-10T06:47:00.001-08:002011-11-10T06:48:29.102-08:00<!--[if gte mso 9]><xml>
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<br />
<div class="WordSection1">
<div align="center" class="MsoNormal" style="tab-stops: 571.5pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;">CEDERA KEPALA</b></div>
<div class="MsoNormal" style="margin-right: 136.8pt;">
<br /></div>
<div class="MsoNormal" style="margin-right: 136.8pt;">
<br /></div>
<div class="MsoNormal" style="margin-right: 136.8pt;">
<b style="mso-bidi-font-weight: normal;">PENGERTIAN</b></div>
<div class="MsoNormal">
Cidera kepala yaitu adanya deformasi berupa penyimpangan
bentuk atau penyimpangan garis pada tulang tengkorak, percepatan dan
perlambatan (accelerasi - decelerasi ) yang merupakan perubahan bentuk
dipengaruhi oleh perubahan peningkatan pada percepatan faktor dan penurunan
kecepatan, serta notasi yaitu pergerakan pada kepala dirasakan juga oleh otak
sebagai akibat perputaran pada tindakan pencegahan.</div>
<div class="MsoNormal" style="margin-right: 136.8pt;">
<br /></div>
<div class="MsoNormal" style="margin-right: 136.8pt;">
<b style="mso-bidi-font-weight: normal;">PATOFISIOLOGI</b></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
Otak dapat berfungsi dengan baik
bila kebutuhan oksigen dan glukosa dapat terpenuhi. Energi yang dihasilkan
didalam sel-sel saraf hampir seluruhnya melalui proses oksidasi. Otak tidak
mempunyai cadangan oksigen, jadi kekurangan aliran darah ke otak walaupun
sebentar akan menyebabkan gangguan fungsi. Demikian pula dengan kebutuhan
oksigen sebagai bahan bakar metabolisme otak tidak boleh kurang dari 20 mg %,
karena akan menimbulkan koma. Kebutuhan glukosa sebanyak 25 % dari seluruh
kebutuhan glukosa tubuh, sehingga bila kadar glukosa plasma turun sampai 70 %
akan terjadi gejala-gejala permulaan disfungsi cerebral.</div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
Pada saat otak mengalami
hipoksia, tubuh berusaha memenuhi kebutuhan oksigen melalui proses metabolik
anaerob yang dapat menyebabkan dilatasi pembuluh darah. Pada kontusio berat,
hipoksia atau kerusakan otak akan terjadi penimbunan asam laktat akibat
metabolisme anaerob. Hal ini akan menyebabkan asidosis metabolik.</div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
Dalam keadaan normal cerebral
blood flow (CBF) adalah 50 - 60 ml / menit / 100 gr. jaringan otak, yang
merupakan 15 % dari cardiac output.</div>
<div class="MsoNormal">
Trauma kepala meyebabkan perubahan fungsi jantung sekuncup
aktivitas atypical-myocardial, perubahan tekanan vaskuler dan udem paru.
Perubahan otonom pada fungsi ventrikel adalah perubahan gelombang T dan P dan
disritmia, fibrilasi atrium dan vebtrikel, takikardia.</div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
Akibat adanya perdarahan otak
akan mempengaruhi tekanan vaskuler, dimana penurunan tekanan vaskuler
menyebabkan pembuluh darah arteriol akan berkontraksi . Pengaruh persarafan
simpatik dan parasimpatik pada pembuluh darah arteri dan arteriol otak tidak
begitu besar.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<b style="mso-bidi-font-weight: normal;">Cedera kepala menurut patofisiologi dibagi menjadi dua :</b></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">CEDERA KEPALA PRIMER</b></div>
<div class="MsoNormal">
Akibat langsung pada mekanisme dinamik (acelerasi -
decelerasi rotasi ) yang menyebabkan gangguan pada jaringan.</div>
<div class="MsoNormal">
Pada cedera primer dapat terjadi :</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; text-indent: 0cm;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gegar kepala ringan</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo2; text-indent: 0cm;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memar otak</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l3 level1 lfo3; text-indent: 0cm;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Laserasi</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">CEDERA KEPALA
SEKUNDER</b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l6 level1 lfo4; text-indent: 0cm;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pada cedera kepala sekunder akan timbul gejala, seperti
:</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l6 level1 lfo5; text-indent: 0cm;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Hipotensi sistemik</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l6 level1 lfo6; text-indent: 0cm;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Hipoksia</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l6 level1 lfo7; text-indent: 0cm;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Hiperkapnea</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l6 level1 lfo8; text-indent: 0cm;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Udema otak</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l6 level1 lfo9; text-indent: 0cm;">
<span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span>Komplikasi pernapasan </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Infeksi / komplikasi pada organ tubuh yang lain</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">PERDARAHAN YANG
SERING DITEMUKAN </b></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Epidural Hematoma</b></div>
<div class="MsoNormal">
Terdapat pengumpulan darah di antara tulang tengkorak dan
duramater akibat pecahnya pembuluh darah / cabang - cabang arteri meningeal
media yang terdapat di duramater, pembuluh darah ini tidak dapat menutup
sendiri<span style="mso-spacerun: yes;"> </span>karena itu sangat berbahaya.
Dapat terjadi dalam beberapa jam sampai 1-2 hari. Lokasi yang paling sering
yaitu di lobus temporalis dan parietalis.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Gejala-gejala yang terjadi :</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Penurunan tingkat kesadaran</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri kepala</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Muntah</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hemiparesis</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dilatasi pupil ipsilateral</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pernapasan dalam cepat kemudian dangkal
irreguler</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Penurunan nadi</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Peningkatan suhu</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Subdural Hematoma</b></div>
<div class="MsoNormal">
Terkumpulnya darah antara duramater dan jaringan otak, dapat
terjadi akut dan kronik. Terjadi akibat pecahnya pembuluh darah vena / jembatan
vena yang biasanya terdapat diantara duramater, perdarahan lambat dan sedikit.
Periode akut terjadi dalam 48 jam - 2 hari atau 2 minggu dan kronik dapat
terjadi dalam 2 minggu atau beberapa bulan.</div>
<div class="MsoNormal">
Tanda-tanda dan gejalanya adalah :</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri kepala</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bingung</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Mengantuk</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Menarik diri</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berfikir lambat</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kejang</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Udem pupil</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Perdarahan intracerebral berupa perdarahan di jaringan otak
karena pecahnya pembuluh darah arteri; kapiler; vena.</div>
<div class="MsoNormal">
Tanda dan gejalanya :</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri kepala</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Penurunan kesadaran</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Komplikasi pernapasan</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hemiplegia kontra lateral</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dilatasi pupil</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Perubahan tanda-tanda vital</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Perdarahan
Subarachnoid</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Perdarahan di dalam rongga subarachnoid akibat robeknya
pembuluh darah<span style="mso-spacerun: yes;"> </span>dan permukaan otak,
hampir selalu ada pad cedera kepala yang hebat.</div>
<div class="MsoNormal">
Tanda dan gejala :</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri kepala</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Penurunan kesadaran</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hemiparese</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dilatasi pupil ipsilateral</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kaku kuduk</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">PENGKAJIAN</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo11; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengumpulan data klien baik subyektif atau obyektif
pada gangguan sistem persarafan sehubungan dengan cedera kepala tergantung pada
bentuk, lokasi, jenis injuri dan adanya komplikasi pada organ vital lainnya.
Data yang perlu didapati adalah sebagai berikut :</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo12; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Identitas klien dan keluarga (penanggung jawab): nama,
umur, jenis kelamin, agama, suku bangsa, status perkawinan, alamat, golongan
darah, pengahasilan, hubungan klien dengan penanggung jawab.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo13; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat kesehatan :</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Tingkat kesadaran / GCS ( < 15 )</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Confulsi</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Muntah</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Dispnea / takipnea</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Sakit kepala</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Wajah simetris / tidak</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Lemah</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Luka di kepala</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Paralise</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Akumulasi sekret pada saluran napas</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Adanya liquor dari hidung dan telinga</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kejang</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 36.0pt;">
Riwayat penyakit
dahulu haruslah diketahui baik yang berhubungan dengan sistem persarafan maupun
penyakit sistem sistemik lainnya. demikian pula riwayat penyakit keluarga
terutama yang mempunyai penyakit menular.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 36.0pt;">
Riwayat kesehatan
tersebut dapat dikaji dari klien atau keluarga sebagai data subyektif.
Data-data ini sangat berarti karena dapat mempengaruhi prognosa klien.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo14; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemeriksaan Fisik</div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
Aspek neurologis yang dikaji
adalah tingkat kesadaran, biasanya GCS < 15, disorientasi orang, tempat dan
waktu. Adanya refleks babinski yang positif, perubahan nilai tanda-tanda vital
kaku kuduk, hemiparese.</div>
<div class="MsoNormal">
Nervus cranialis dapat terganggu bila cedera kepala meluas
sampai batang otak karena udema otak atau perdarahan otak juga mengkaji nervus
I, II, III, V, VII, IX, XII.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l9 level1 lfo15; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemeriksaan Penujang</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>CT-Scan (dengan atau tanpa kontras) :
mengidentifikasi luasnya lesi, perdarahan, determinan ventrikuler, dan
perubahan jaringan otak. Catatan : Untuk mengetahui adanya infark / iskemia
jangan dilekukan pada 24 - 72 jam setelah injuri.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>MRI : Digunakan sama seperti CT-Scan dengan atau
tanpa kontras radioaktif.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Cerebral Angiography: Menunjukan anomali
sirkulasi cerebral, seperti : perubahan jaringan otak sekunder menjadi udema,
perdarahan dan trauma.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Serial EEG: Dapat melihat perkembangan gelombang
yang patologis</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>X-Ray: Mendeteksi perubahan struktur tulang
(fraktur), perubahan struktur garis(perdarahan/edema), fragmen tulang.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>BAER: Mengoreksi batas fungsi corteks dan otak
kecil</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>PET: Mendeteksi perubahan aktivitas<span style="mso-spacerun: yes;"> </span>metabolisme otak</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>CSF, Lumbal Punksi :Dapat dilakukan jika diduga
terjadi perdarahan subarachnoid.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>ABGs: Mendeteksi keberadaan ventilasi atau
masalah<span style="mso-spacerun: yes;"> </span>pernapasan (oksigenisasi) jika
terjadi peningkatan tekanan intrakranial</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kadar Elektrolit : Untuk mengkoreksi
keseimbangan elektrolit sebagai akibat peningkatan tekanan intrkranial</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Screen Toxicologi: Untuk mendeteksi pengaruh
obat sehingga menyebabkan penurunan kesadaran.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Penatalaksanaan</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
Konservatif:</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: 18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bedrest total</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: 18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pemberian obat-obatan</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: 18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Observasi tanda-tanda vital (GCS dan tingkat
kesadaran)</div>
<div class="MsoNormal" style="text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Prioritas Perawatan:</b></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo16; text-indent: 18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Maksimalkan perfusi / fungsi otak</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo17; text-indent: 18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah komplikasi</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo18; text-indent: 18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengaturan fungsi secara optimal / mengembalikan ke
fungsi normal</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l5 level1 lfo19; text-indent: 18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mendukung proses pemulihan koping klien / keluarga</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l5 level1 lfo20; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemberian informasi tentang proses penyakit, prognosis,
rencana pengobatan, dan rehabilitasi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Tujuan:</b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l8 level1 lfo21; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Fungsi otak membaik : defisit neurologis
berkurang/tetap</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l8 level1 lfo22; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Complikasi tidak terjadi</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l8 level1 lfo23; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kebutuhan sehari-hari dapat dipenuhi sendiri atau
dibantu orang lain</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l8 level1 lfo24; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Keluarga dapat menerima kenyataan dan berpartisipasi
dalam perawatan</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l8 level1 lfo25; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Proses penyakit, prognosis, program pengobatan dapat
dimengerti oleh keluarga sebagai sumber informasi.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Diagnosa Keperawatan yang biasanya muncul adalah:</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level1 lfo26; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tidak efektifnya pola napas sehubungan dengan depresi
pada pusat napas di otak.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level1 lfo27; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tidakefektifnya kebersihan jalan napas sehubungan
dengan penumpukan sputum.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level1 lfo28; text-indent: -18.0pt;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></i>Gangguan
perfusi jaringan otak sehubungan dengan udem otak</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level1 lfo29; text-indent: -18.0pt;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></i>Keterbatasan
aktifitas sehubungan dengan penurunan kesadaran (soporos - coma )<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level1 lfo30; text-indent: -18.0pt;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></i>Potensial
gangguan integritas kulit sehubungan dengan immobilisasi, tidak adekuatnya
sirkulasi perifer.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: l2 level1 lfo31; text-indent: -18.0pt;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></i>Kecemasan
keluarga sehubungan keadaan yang kritis pada pasien.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: -18.0pt;">
<br /></div>
</div>
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 16.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; mso-font-kerning: 14.0pt;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span></b>
<div class="WordSection2">
<div class="MsoTitle">
<span style="font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">DAFTAR KEPUSTAKAAN</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
Doenges M.E. (1989) <u>Nursing Care
Plan</u>, Guidlines for Planning Patient Care (2 nd ed ). Philadelpia, F.A.
Davis Company.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
Long; BC and Phipps WJ (1985) <u>Essential
of Medical Surgical Nursing : A Nursing Process Approach</u> St. Louis. Cv.
Mosby Company.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
Asikin Z (1991) <u>Simposium
Keperawatan Penderita Cedera Kepala</u>. </div>
<div class="MsoNormal" style="mso-list: skip;">
Panatalaksanaan Penderita dengan Alat
Bantu Napas, Jakarta.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<span style="mso-bidi-font-weight: bold;">Harsono (1993)<u> Kapita Selekta Neurologi, </u>Gadjah Mada University
Press</span></div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
</div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span></b>
<div class="WordSection3">
<div class="MsoNormal" style="mso-list: skip;">
<b style="mso-bidi-font-weight: normal;">Beberapa
diagnosa perawatan yang dapat dibuat untuk pasien dengan cedera kepala adalah :</b></div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i>Tidak efektifnya pola napas
sehubungan dengan depresi pada pusat napas di otak.</i></div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Tujuan
: </i></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Mempertahankan pola
napas yang efektif melalui ventilator.</div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Kriteria
evaluasi :</i></div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 36.0pt;">
Penggunaan otot
bantu napas tidak ada, sianosis tidak ada atau tanda-tanda hipoksia tidak ada
dan gas darah dalam batas-batas normal.</div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Rencana
tindakan :</i></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Hitung pernapasan pasien dalam satu menit.<span style="mso-spacerun: yes;"> </span>pernapasan yang cepat dari pasien dapat
menimbulkan alkalosis respiratori dan pernapasan lambat meningkatkan tekanan Pa
Co2 dan menyebabkan asidosis respiratorik.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Cek pemasangan tube, untuk memberikan ventilasi
yang adekuat dalam pemberian tidal volume.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Observasi ratio inspirasi dan ekspirasi pada
fase ekspirasi biasanya 2 x lebih panjang dari inspirasi, tapi dapat lebih
panjang sebagai kompensasi terperangkapnya udara terhadap gangguan pertukaran
gas.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Perhatikan kelembaban dan suhu pasien keadaan
dehidrasi dapat mengeringkan sekresi / cairan paru sehingga menjadi kental dan
meningkatkan resiko infeksi.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Cek selang ventilator setiap waktu (15 menit ),
adanya obstruksi dapat menimbulkan tidak adekuatnya pengaliran volume dan
menimbulkan penyebaran udara yang tidak adekuat.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Siapkan ambu bag tetap berada di dekat pasien,
membantu membarikan ventilasi yang adekuat bila ada gangguan pada ventilator. </div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i>Tidak efektifnya kebersihan jalan
napas sehubungan dengan penumpukan sputum</i>.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Tujuan
:</i></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Mempertahankan
jalan napas dan mencegah aspirasi</div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Kriteria
Evaluasi :</i></div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 36.0pt;">
Suara napas bersih,
tidak terdapat suara sekret pada selang dan bunyi alarm karena peninggian suara
mesin, sianosis tidak ada.</div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Rencana
tindakan :</i></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kaji dengan ketat (tiap 15 menit) kelancaran
jalan napas. Obstruksi dapat disebabkan pengumpulan sputum, perdarahan,
bronchospasme atau masalah terhadap tube.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Evaluasi pergerakan dada dan auskultasi dada
(tiap 1 jam ). Pergerakan yang simetris dan suara napas yang bersih indikasi
pemasangan tube yang tepat dan tidak adanya penumpukan sputum.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Lakukan pengisapan lendir dengan waktu kurang
dari 15 detik bila sputum banyak. Pengisapan lendir tidak selalu rutin dan
waktu harus dibatasi untuk mencegah hipoksia.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Lakukan fisioterapi dada setiap 2 jam.
Meningkatkan ventilasi untuk semua bagian paru dan memberikan kelancaran aliran
serta pelepasan sputum.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal">
<i>Gangguan perfusi jaringan otak sehubungan dengan udem
otak</i></div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Tujuan
:</i></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Mempertahankan dan
memperbaiki tingkat kesadaran fungsi motorik.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Kriteria
hasil :</i></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Tanda-tanda vital
stabil, tidak ada peningkatan intrakranial.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Rencana
tindakan :</i></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l7 level1 lfo38; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span>Monitor
dan catat status neurologis dengan menggunakan metode GCS.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip;">
Rasional :<span style="mso-spacerun: yes;"> </span>Refleks membuka mata menentukan pemulihan
tingkat kesadaran. </div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip;">
Respon motorik
menentukan kemampuan berespon terhadap stimulus eksternal dan indikasi keadaan
kesadaran yang baik.</div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip;">
Reaksi pupil
digerakan oleh saraf kranial oculus motorius dan untuk menentukan refleks
batang otak.</div>
<div class="MsoNormal" style="margin-left: 72.0pt; mso-list: skip;">
Pergerakan mata
membantu menentukan area cedera dan tanda awal peningkatan tekanan intracranial
adalah terganggunya abduksi mata.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo32; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitor tanda-tanda<span style="mso-spacerun: yes;">
</span>vital tiap 30 menit.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: 36.0pt;">
Peningkatan
sistolik dan penurunan diastolik serta penurunan tingkat kesadaran dan
tanda-tanda peningkatan tekanan intrakranial. Adanya pernapasan yang irreguler
indikasi terhadap adanya peningkatan metabolisme sebagai reaksi terhadap
infeksi. Untuk mengetahui tanda-tanda keadaan syok akibat perdarahan.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 0cm; mso-list: l1 level1 lfo33; text-indent: 0cm;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></i>Pertahankan
posisi kepala yang sejajar dan tidak menekan. </div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip; text-indent: 54.0pt;">
Perubahan
kepala pada satu sisi dapat menimbulkan penekanan pada vena jugularis dan
menghambat aliran darah otak, untuk itu dapat meningkatkan tekanan
intrakranial.</div>
<div class="MsoNormal" style="margin-left: 35.45pt; mso-list: skip; text-indent: -35.45pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo34; tab-stops: 35.45pt; text-indent: -18.0pt;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></i>Hindari batuk yang berlebihan, muntah, mengedan,
pertahankan pengukuran urin dan hindari konstipasi yang berkepanjangan.</div>
<div class="MsoNormal" style="margin-left: 54.0pt; mso-list: skip; text-indent: -36.0pt;">
Dapat
mencetuskan respon otomatik penngkatan intrakranial.</div>
<div class="MsoNormal" style="margin-left: 35.45pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo35; text-indent: -18.0pt;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></i>Observasi
kejang dan lindungi pasien dari cedera akibat kejang.<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;"><span style="mso-spacerun: yes;"> </span></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip;">
Kejang terjadi
akibat iritasi otak, hipoksia, dan kejang dapat meningkatkan tekanan
intrakrania.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 0cm; mso-list: l1 level1 lfo36; text-indent: 0cm;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></i>Berikan
oksigen sesuai dengan kondisi pasien. </div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 18.0pt;">
Dapat menurunkan
hipoksia otak. </div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l1 level1 lfo37; text-indent: -18.0pt;">
<i style="mso-bidi-font-style: normal;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></i>Berikan
obat-obatan yang diindikasikan dengan tepat dan benar (kolaborasi). </div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip;">
Membantu menurunkan
tekanan intrakranial secara biologi / kimia seperti osmotik diuritik untuk<span style="mso-spacerun: yes;"> </span>menarik air dari sel-sel otak sehingga dapat
menurunkan udem otak, steroid (dexametason) untuk menurunkan inflamasi,
menurunkan edema jaringan. Obat anti kejang untuk menurunkan kejang, analgetik
untuk menurunkan rasa nyeri efek negatif dari peningkatan tekanan intrakranial.
Antipiretik untuk menurunkan panas yang dapat meningkatkan pemakaian oksigen
otak.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i style="mso-bidi-font-style: normal;">Keterbatasan aktifitas
sehubungan dengan penurunan kesadaran (soporos - coma ) </i></div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Tujuan
:</i></div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 36.0pt;">
Kebutuhan dasar
pasien dapat terpenuhi secara adekuat.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Kriteria
hasil :</i></div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 36.0pt;">
Kebersihan terjaga,
kebersihan lingkungan terjaga, nutrisi terpenuhi sesuai dengan kebutuhan,
oksigen adekuat.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Rencana
Tindakan :</i></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Berikan penjelasan
tiap kali melakukan tindakan pada pasien. </div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Penjelasan dapat
mengurangi kecemasan dan meningkatkan kerja sama yang dilakukan pada pasien
dengan kesadaran penuh atau menurun.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Beri bantuan untuk
memenuhi kebersihan diri.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Kebersihan
perorangan, eliminasi, berpakaian, mandi, membersihkan mata dan kuku, mulut,
telinga, merupakan kebutuhan dasar akan kenyamanan yang harus dijaga oleh
perawat untuk meningkatkan rasa nyaman, mencegah infeksi dan keindahan.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Berikan bantuan
untuk memenuhi kebutuhan nutrisi dan cairan.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Makanan dan minuman
merupakan kebutuhan sehari-hari yang harus dipenuhi untuk menjaga kelangsungan
perolehan energi. Diberikan sesuai dengan kebutuhan pasien baik jumlah, kalori,
dan waktu.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Jelaskan pada
keluarga tindakan yang dapat dilakukan untuk menjaga lingkungan yang aman dan
bersih.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Keikutsertaan
keluarga diperlukan untuk menjaga hubungan klien - keluarga. Penjelasan perlu
agar keluarga dapat memahami peraturan yang ada di ruangan.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Berikan bantuan
untuk memenuhi kebersihan dan keamanan lingkungan.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Lingkungan yang
bersih dapat mencegah infeksi dan kecelakaan.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Kecemasan
keluarga sehubungan keadaan yang kritis pada pasien.</i></div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Tujuan
:</i></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Kecemasan keluarga
dapat berkurang</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Kriteri
evaluasi :</i></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Ekspresi wajah
tidak menunjang adanya kecemasan</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Keluarga mengerti
cara berhubungan dengan pasien</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Pengetahuan
keluarga mengenai keadaan, pengobatan dan tindakan meningkat.</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Rencana
tindakan :</i></div>
<div class="MsoNormal" style="margin-left: 0cm; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Bina hubungan saling percaya.</div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 18.0pt;">
Untuk membina hubungan
terpiutik perawat - keluarga.</div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 18.0pt;">
Dengarkan dengan
aktif dan empati, keluarga akan merasa diperhatikan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Beri penjelasan tentang semua prosedur dan
tindakan yang akan dilakukan pada pasien.</div>
<div class="MsoNormal" style="mso-list: skip; text-indent: 18.0pt;">
Penjelasan akan
mengurangi kecemasan akibat ketidak tahuan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan kesempatan pada keluarga untuk bertemu
dengan klien. </div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip;">
Mempertahankan
hubungan pasien dan keluarga.</div>
<div class="MsoNormal" style="margin-left: 0cm; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan dorongan spiritual untuk keluarga.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: skip;">
Semangat keagamaan
dapat mengurangi rasa cemas dan meningkatkan keimanan dan ketabahan dalam
menghadapi krisis.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
<i style="mso-bidi-font-style: normal;">Potensial
gangguan integritas kulit sehubungan dengan immobilisasi, tidak adekuatnya
sirkulasi perifer.</i></div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
Tujuan :</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
Gangguan integritas
kulit tidak terjadi</div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: skip;">
<br /></div>
<div class="MsoNormal" style="mso-list: skip;">
Rencana tindakan :</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; tab-stops: 36.0pt; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kaji fungsi motorik dan sensorik pasien dan
sirkulasi perifer untuk menetapkan kemungkinan terjadinya lecet pada kulit.</div>
<div class="MsoNormal" style="margin-left: 0cm; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kaji kulit pasien setiap 8 jam : palpasi pada
daerah yang tertekan.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; tab-stops: 0cm; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan posisi dalam sikap anatomi dan gunakan
tempat kaki untuk daerah yang menonjol.</div>
<div class="MsoNormal" style="margin-left: 0cm; mso-list: l0 level1 lfo10; text-indent: 0cm;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Ganti posisi pasien setiap 2 jam</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pertahankan kebersihan dan kekeringan pasien :
keadaan lembab akan memudahkan terjadinya kerusakan kulit.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Massage dengan lembut di atas daerah yang
menonjol setiap 2 jam sekali.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Pertahankan alat-alat tenun tetap bersih dan
tegang.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kaji daerah kulit yang lecet untuk adanya
eritema, keluar cairan setiap 8 jam.</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo10; text-indent: -18.0pt;">
<span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Berikan perawatan kulit pada daerah yang rusak /
lecet setiap 4 - 8 jam dengan menggunakan H2O2.</div>
<div class="MsoNormal" style="mso-list: skip;">
<br /></div>
</div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
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<div class="MsoNormal" style="mso-list: skip;">
KEPERAWATAN KLIEN DENGAN PEMASANGAN
GIPS</div>
<div class="MsoNormal">
Tujuan Pemasangan Gips</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo39; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span>untuk
immobilisasi, mensupport dan melindungi selama proses penyembuhan patah tulang</div>
<div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l4 level1 lfo39; tab-stops: list 18.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span>mencegah
atau memperbaiki deformitas</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Indikasi :</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
1. Immobilisasi dan penyangga
fraktur</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
2. Stabilisasi</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
3. Koreksi deformitas</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
4. Mengurangi aktifitas pada
daerah yang terinfeksi</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
5. Membuat cetakan tubuh untuk
orthotic</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
Tujuan Dilakukan Window/Jendela Gips</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
1. Untuk memeriksa luka</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
2. Untuk membuka jahitan</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
3. Untuk memeriksa adanya
penekanan</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
4. Membuang atau mengangkat benda
asing</div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
5. Mengurangi penekanan</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Hal-hal Yang Harus Diperhatikan Pada Pemasangan Gips :</div>
<div class="MsoNormal" style="margin-left: 50.2pt; text-indent: -14.2pt;">
1. Gips yang
ideal adalah yang dapat membungkus tubuh/sesuai dengan bentuk<span style="mso-spacerun: yes;"> </span>tubuh<span style="mso-spacerun: yes;">
</span>(ekstremitas)</div>
<div class="MsoNormal" style="margin-left: 50.2pt; text-indent: -14.2pt;">
2.<span style="mso-spacerun: yes;"> </span>Gips yang pas tidak akan menyebabkan
perlukaan</div>
<div class="MsoNormal" style="margin-left: 50.2pt; text-indent: -14.2pt;">
3.<span style="mso-spacerun: yes;"> </span>Gips yang sudah patah adalah gips yang tidak
dapat digunakan</div>
<div class="MsoNormal" style="margin-left: 50.2pt; text-indent: -14.2pt;">
4.<span style="mso-spacerun: yes;"> </span>Gips yang terlalu kecil dan terlalu longgar
sangat membahayakan klien</div>
<div class="MsoNormal" style="margin-left: 50.2pt; text-indent: -14.2pt;">
5.<span style="mso-spacerun: yes;"> </span>Perawatan gips dilakukan selama gips masih
dipakai </div>
<div class="MsoNormal" style="margin-left: 50.2pt; text-indent: -14.2pt;">
6.<span style="mso-spacerun: yes;"> </span>Jangan merusak atau menekan gips</div>
<div class="MsoNormal" style="margin-left: 50.2pt; text-indent: -14.2pt;">
7.<span style="mso-spacerun: yes;"> </span>Jangan memasukan benda asing atau menggaruk
ke dalam gips</div>
<div class="MsoNormal" style="margin-left: 50.2pt; text-indent: -14.2pt;">
8.<span style="mso-spacerun: yes;"> </span>Jangan meletakan gips lebih rendah dari tubuh
dalam waktu yang lama</div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-66797558420414159732011-11-10T06:39:00.001-08:002011-11-10T06:44:05.437-08:00askep kraniotomi<!--[if gte mso 9]><xml>
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<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">LAPORAN PENDAHULUAN</span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">ASUHAN
KEPERAWATAN PADA KLIEN </span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">DENGAN
POST CRANIOTOMI E.C NEOPLASMA </span></b><b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">A. Definisi</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-outline-level: 2; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-outline-level: 2; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor adalah istilah umum yang
mencakup setiap pertumbuhan benigna (jinak) dalam setiap bagian tubuh.
Pertmbuhan ini tidak bertujuan, bersifat parasit dan berkembang dengan
mengorbankan manusia yang menjadi hospesnya. (Sue Hinchliff, 1997).</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-outline-level: 2; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor otak </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-outline-level: 2; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor otak<span style="mso-spacerun: yes;"> </span>adalah tumor jinak pada selaput otak atau
salah satu otak. (Rosa Marion, 2000)</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-outline-level: 2; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Karsinoma otak (maligna) </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-outline-level: 2; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Karsnoma otak adalah neoplasma yang
tumbuh di selaput otak.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-outline-level: 2; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Neoplasama </span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-outline-level: 2; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Neoplasma ialah sekumpulan sel
abnormal yang terbentuk oleh sel-sel yang tumbuh terus menerus secara terbatas,
tidak terkoordinasi dengan jaringan sekitarnya dan tidak berguna bagi tubuh. (Achmad
Tjarta, 1973).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 15.3pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">B</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. <b style="mso-bidi-font-weight: normal;">Etiologi</b></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyeban
tumor otak belum diketahui pasti, tapi dapat diperkirakan karena :</span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Genetik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor susunan saraf pusat primer
nerupakan komponen besar dari beberapa gangguan yang diturunkan sebagi kondisi
autosomal, dominant termasuk sklerasis tuberose, neurofibromatosis.</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kimia dan Virus</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada
binatang telah ditemukan bahwa karsinogen kimia dan virus menyebabkan
terbentuknya neoplasma primer susunan saraf pusat tetapi hubungannya dengan
tumor pada manusia masih belum jelas.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Radiasi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada
manusia susunan saraf pusat pada masa kanak-kanak menyebablkan terbentuknya
neoplasma setelah dewasa.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo2; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Trauma</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Trauma
yang berulang menyebabkan terjadinya meningioma (neoplasma selaput otak).
Pengaruh trauma pada patogenesis neoplasma susunan saraf pusat belum diketahui.</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">C. <b style="mso-bidi-font-weight: normal;">Klasifikasi</b></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo3; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Glioma </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Jumlah
½ tumor otak. Tumbuh pada tiap jaringan dari otak. Infiltrasi dari terutama ke
jaringan hemisfer cerebral. Tumbuh sangat cepat, sebagian orang bias hidup
beberapa bulan sampai tahun.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo3; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Meningoma</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dari
13 % sampai 18 % merupakan tumor primer intracranial. Tumbuh dari selaput
meningeal otak. Biasanya jinak tapi bisa berubah menjadi maligna. Biasanya
berkapsul dan penyembuhan melaui bedah sangat mungkin. Pertumbuhan kembali
mungkin</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo3; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor Pituitari </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor
pada semua kelompok umur, tapi lebih sering pada wanita. Tumbuh dari berbagai
jenis jaringan. Pendekatan pembedahan biasanya berhasil. Kekembuhan kembali
mungkin.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo3; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Neuroma (Schwannoma, neuro)</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Neuroma
akustik sangat sering. Tumbuh dari sel-sel Schwann di dalam meatus auditori
pada bagian vestibular saraf cranial III. Biasanya jinak bisa berubah menjadi
maligna. Akan tmbuh kembali bila tidak terangkat lengkap. Reseksi bedah sukar
karena lokasinya.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo3; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor Metastase</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dari
2 % sampai 20 % penderita kanker terjadi metastase ke otak Sel kanker
menjangkau otak lewat sistem sirkulasi. Reaksi bedah sangat sukar, pemgobatan
kurang berhasil. Pemulihan dibawah satu tahun atau dua tahun tidak biasa.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">D.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> <b style="mso-bidi-font-weight: normal;">Patofisiologi</b></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor
otak menyebabkan gangguan neurologik progresif. Gangguan neurologik pada tumor
otak biasanya dianggap disebabkan oleh dua faktor yaitu gangguan fokal disebabkan
oleh tumor dan kenaikan tekanan intrakranial. Gangguan fokal terjadi apabila
terdapat penekanan pada jaringan otak, dan infiltrasi atau invasi langsung pada
parenkim otak dengan kerusakan jaringan neuron.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan
suplai darah akibat tekanan yang ditimbulkan tumor yang bertumbuh menyebabkan
nekrosis jaringan otak. Gangguan suplai darah arteri pada umumnya
bermanifestasi sebagai kehilangan fungsi secara akut dan mungkin dapat
dikacaukan dengan gangguan serebrovaskuler primer.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Serangan
kejang sebagai gejala perunahan kepekaan neuron dihubungkan dengan kompesi
invasi dan perubahan suplai darah ke jaringan otak. Bebrapa tumor membentuk
kista yang juga menekan parenkim otak sekitarnya sehingga memperberat ganggguan
neurologist fokal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peningkatan
tekanan intrakranial dapat diakibatkan oleh beberapa faktor yaitu bertambahnya
massa dalam tengkorak, terbentuknya edema sekitar tumor, dan perubahan sirkulasi
cairan serebrospinal.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Beberapa
tumor dapat menyebabkan perdarahan. Obstruksi vena dan edema yang disebabkan oleh
kerusakan sawar darah otak. Semuanya menimbulkan kenaikan volume intracranial
dan meningkatkan tekanan intracranial. Obstruksi sirkulasi cairan serebrospinal
dari ventrikel lateral ke ruangan subaraknoid menimbulkan hidrosefalus.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peningkatan
tekanan intrakranial akan membahayakan jiwa. Mekanisme kompensasi memerlukan
waktu lama untuk menjadi efektif dan oleh karena itu tak berguna apabila
tekanan intrakranial timbul cepat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Mekanisme
kompensasi ini antara lain bekerja menurunkan volume darah intracranial, volume
cairan serebrospinal, kandungan cairan intrasel dan mengurangi sel-sel
parenkim, kenaikan tekanan yang tidak diobati mengakibatkan herniasi unkus atau
serebelum yang timbul bilagirus medialis lobus temporalis bergeser ke inferior
melalui insisura tentorial oleh massa dalam hemisfer otak. Herniasi menekan
mesensenfalon, menyebabkan hilangnya kesadaran dan menekan saraf otak ketiga.
Kompresi medula oblogata dan henti pernafasan terjadi dengan cepat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan
fisiologi lain terjadi akibat peningkatan intracranial yang cepat adalah
bradikardia progresif, hipertensi sistemik (pelebaran tekanan nadi), dan
gangguan pernafasan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pathway (terlampir)</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-outline-level: 2; text-align: justify; text-indent: 21.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">E. Tanda dan Gejala</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tanda dan gejala tumor otak sangat
bervariasi, tergantung pada tempat lesi dan kecepatan pertumbuhannya, antara
lain :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="mso-spacerun: yes;">
</span>Lobus Frontalis </span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan kepribadian</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Epilepsi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Afasia mototik</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hemiparesis</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ataksia</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan bicara</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo4; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan gaya berjalan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Lobus Oksipitalis </span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan penglihatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Lobus Temporalis Halusinasi</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kejang psikomotor</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tinitus (bunyi berdengung atau
berdesing)</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo5; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kesulitan menyebutkan objek</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Lobus Parietalis </span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo6; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tidak mampu merekam gambar</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo6; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tidak dapat membedakan mana kiri
mana kanan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">F. Pemeriksaan Diagnostik</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.
Arterigrafi atau Ventricolugram ; untuk mendeteksi kondisi patologi pada sistem
ventrikel dan cisterna.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. CT –
SCAN ; Dasar dalam menentukan diagnosa.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.
Radiogram ; Memberikan informasi yang sangat berharga mengenai struktur,
penebalan dan klasifikasi; posisi kelenjar pinelal yang mengapur; dan posisi
selatursika.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d. Elektroensefalogram
(EEG) : Memberi informasi mengenai perubahan kepekaan neuron.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e. Ekoensefalogram
: Memberi informasi mengenai pergeseran kandungan intra serebral.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f. <span style="mso-spacerun: yes;"> </span>Sidik otak radioaktif<span style="mso-spacerun: yes;"> </span>: Memperlihatkan daerah-daerah akumulasi
abnormal dari zat radioaktif. Tumor otak mengakibatkan kerusakan sawar darah
otak yang menyebabkan akumulasi abnormal zat radioaktif.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">G. <span style="mso-spacerun: yes;"> </span>Penatalaksanaan Medis</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pembedahan
dengan craniotomy</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Radiotherapi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Biasanya merupakan kombinasi dari
terapi lainnya tapi tidak jarang pula merupakan therapi tunggal. Adapun efek
samping : kerusakan kulit di sekitarnya, kelelahan, nyeri karena inflamasi pada
nervus atau otot pectoralis, radang tenggorkan.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kemoterapi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pemberian obat-obatan anti tumor
yang sudah menyebar dalam aliran darah.<br />
Efek samping : lelah, mual, muntah, hilang nafsu makan, kerontokan membuat,
mudah terserang penyakit.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Manipulasi
hormonal.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Biasanya dengan obat golongan
tamoxifen untuk tumor yang sudah bermetastase.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Psikologi</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan penatalaksanaan unit gawat
darurat pada injury kepala pasien yang post-operative adalah sama sepeti
pre-operativ, yakni: optimisasi physiologic. Prinsip kontrol tekanan
intracranial dan optimisasi perfusi tekanan cerebral seperti halnya pemeliharaan
oxygenation yang cukup dari perfusi darah :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ventilasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-align: justify;">
<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hyperventilation bukanlah suatu therapy yang tidak berbahaya (
disebabkan alkalosis, hypokalemia, vasoconstricsi dengan ischemia) dan
bagaimanapun secara relatif tidak efektif dalam<span style="mso-spacerun: yes;">
</span>pengerutan pembuluh darah cerebral setelah beberapa jam. Normocapnia
harus dirawat sedapat mungkin. Drainase CSF dari suatu kateter/pipa ventricular
dalam saluran tubuh lebih disukai untuk mereduksi/mengurangi ICP ( dan
optimisasi pada tekanan perfusion cerebral) untuk metabolically deranging
therapies seperti hyperventilation dan diuresis.</span><span lang="IN" style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"></span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Fluids/cairan<span style="color: black;"></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-align: justify;">
<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Walaupun penggantian cairan<span style="mso-spacerun: yes;">
</span>bukan sebagian besar diantaranya intracranial sebagai intra-abdominal
atau perawatan intrathoracic post operasi trauma kepala penatalaksanaan cairan
adalah komplikasi perawatan pada kontrol hipertensi intracranial seperti
diuresis dan hyperventilation kedua-duanya yang mana cenderung<span style="mso-spacerun: yes;"> </span>menyebabkan berkurangnya volume dan
metabolisme alkalosis. Solusinya Isotonik IV harus digunakan dalam semua kasus.
Jumlah volume Darah yang bagus tidak hanya meningkatkan kapasitas oksigen
tetapi juga menyebabkan<span style="mso-spacerun: yes;"> </span>unsur selularnya
tidak pecah ( seperti albumin) ke dalam molekul lebih kecil yang berdifusi ke
membran alveolar<span style="mso-spacerun: yes;"> </span>dalam paru-paru dan
dari intravascular ke ruang extravascular<span style="mso-spacerun: yes;">
</span>yang membawa cairan pada paru-paru dan edema cerebral.</span><span lang="IN" style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-align: justify;">
<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pasien dengan berbagai trauma, laserasi kulit kepala, perdarahan
subdural, dan injury sering kehilangan sejumlah darah dalam jumblah yang besar
pada saat itu mereka tiba di ruang op di ICU. Transfusi diberikan kepada pasien
dengan hematocrit yang rendah<span style="mso-spacerun: yes;"> </span>pada level
kritis (pada umumnya di bawah 25%) terutama ketika disertai<span style="mso-spacerun: yes;"> </span>dengan hypotension, tachycardia, dan
berkurangnya urin output.</span><span lang="IN" style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"></span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Nutrisi
</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-align: justify;">
<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dukungan nuitrisi harus segera setelah trauma kepala craniotomy
ketika pasien bowel sounds. Pemberian makanan Enteral itu baik tidak hanya
untuk mencegah perdarahan tetapi juga nutrisi diatur melalui<span style="mso-spacerun: yes;"> </span>rute ini<span style="mso-spacerun: yes;">
</span>jadi lebih siap diserap dan metabolisme tanpa resiko dari hepatitis,
sepsis, dan komplikasi lain yang berhubungan dengan total parenteral nutrition
( TPN)., seandainya bowel berbunyi adalah suatu pngembalian lambat, TPN yang
pertama dapat dimulai dalam duapuluh empat jam setelah suatu operasi trauma
kepala.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">H. Komplikasi</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Adapun komplikasi yang dapat kita
temukan pada pasien yang menderita tumor otak ialah :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Gangguan fisik neurologist</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. Gangguan kognitif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c. Gangguan tidur dan mood</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d. Disfungsi seksual </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">I. <span style="mso-spacerun: yes;"> </span>ASUHAN KEPERAWATAN</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.
Pengkajian Primer</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">a.
Airway</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Adanya
sumbatan/obstruksi jalan napas oleh adanya penumpukan sekret akibat kelemahan
reflek batuk</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">b.
Breathing</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kelemahan
menelan/ batuk/ melindungi jalan napas, timbulnya pernapasan yang sulit dan /
atau tak teratur, suara nafas terdengar ronchi /aspirasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">c.
Circulation</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">TD
dap<span style="mso-bidi-font-weight: bold;">a</span>t normal atau meningkat ,
hipotensi terjadi pada tahap lanjut, takikardi, bunyi jantung normal pada tahap
dini, disritmia, kulit dan membran mukosa pucat, dingin, sianosis pada tahap
lanjut</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.
Pengkajian Sekunder</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Pola persepsi kesehatan dan
pemeliharaan dan kesehatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Riwayat keluarga denga tumor</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Terpapar radiasi berlebih.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Adanya riwayat masalah
visual-hilang ketajaman penglihatan dan diplopia</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Kecanduan Alkohol, perokok berat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Terjadi perasaan abnormal</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Gangguan kepribadian / halusinasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. Pola nutrisi metabolik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Riwayat epilepsy</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Nafsu makan hilang</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Adanya mual, muntah selama fase
akut</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Kehilangan sensasi pada lidah, pipi
dan tenggorokan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Kesulitan menelan (gangguan pada
refleks palatum dan Faringeal)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c. Pola eliminasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Perubahan pola berkemih dan buang
air besar (Inkontinensia)</span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Bising usus negatif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d. Pola aktifitas dan latihan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Gangguan tonus otot terjadinya
kelemahan otot, gangguan tingkat kesadaran</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Resiko trauma karena epilepsy</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Hamiparase, ataksia</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Gangguan penglihatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -14.15pt;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Merasa mudah lelah, kehilangan
sensasi (Hemiplegia)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e. Pola tidur dan istirahat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Susah untuk beristirahat dan atau
mudah tertidur</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f. Pola persepsi kognitif dan
sensori</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Pusing</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Sakit kepala</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Kelemahan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Tinitus</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Afasia motorik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Hilangnya rangsangan sensorik kontralateral</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Gangguan rasa pengecapan, penciuman
dan penglihatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Penurunan memori, pemecahan masalah</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> kehilangan kemampuan masuknya
rangsang visual</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Penurunan kesadaran sampai dengan
koma.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Tidak mampu merekam gambar</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Tidak mampu membedakan kanan/kiri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g. Pola persepsi dan konsep diri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Perasaan tidak berdaya dan putus
asa</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Emosi labil dan kesulitan untuk
mengekspresikan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h. Pola peran dan hubungan dengan
sesame</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Masalah bicara</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Ketidakmampuan dalam berkomunikasi
( kehilangan komunikasi verbal/ bicara pelo )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i. <span style="mso-spacerun: yes;"> </span>Reproduksi dan seksualitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Adanya gangguan seksualitas dan
penyimpangan seksualitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Pengaruh/hubungan penyakit terhadap
seksualitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">j. <span style="mso-spacerun: yes;"> </span>Pola mekanisme koping dan toleransi terhadap
stress</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Adanya perasaan cemas,takut,tidak
sabar ataupun marah</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Mekanisme koping yang biasa
digunakan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Perasaan tidak berdaya, putus asa</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Respon emosional klien terhadap
status saat ini</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Orang yang membantu dalam pemecahan
masalah</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Mudah tersinggung</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">k. Sistem kepercayaan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">-</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Agama yang dianut, apakah kegiatan
ibadah terganggu </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.
Diagnosa Keperawatan</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pre-Operasi</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo8; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan nutrisi kurang dari
kebutuhan tubuh berhubungan dengan mual, muntah dan tidak nafsu makan /
pertumbuhan sel-sel kanker</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo8; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nyeri kepala berhubungan dengan
proses pertumbuhan sel-sel kanker pada otak/mendesak otak.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo8; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan mobilitas fisik yang
berhubungan dengan gangguan pergerakan dan kelemahan.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo8; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kerusakan komunikasi verbal yang
berhubungan dengan kerusakan sirkulasi serebral.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo8; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan harga diri berhubungan
dengan ketergantungan, perubahan peran, perubahan citra diri</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo8; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kurang pengetahuan tentang kondisi
dan penanganan penyakit berhubungan dengan kurangnya informasi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo8; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kecemasan berhubungan dengan rencana
pembedahan</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Post-Operasi</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo9; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nyeri yang berhubungan dengan efek
dari pembedahan</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo9; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan harga diri berhubungan
dengan ketergantungan, perubahan peran, perubahan citra diri.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo9; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kurang pengetahuan tentang tumor
otak yang berhubungan dengan ketidaktahuan tentang sumber informasi</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo9; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kecemasan yang berhubungan dengan
penyakit kronis dan masa depan yang tidak pasti.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.
Rencana</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> <b style="mso-bidi-font-weight: normal;">Keperawatan</b></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pre-Operasi</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
1. Nyeri berhubungan dengan proses pertumbuhan sel-sel kanker</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 3;"> </span>: Nyeri berkurang sampai hilang setelah dilakukan
tindakan keperawatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hasil yang diharapkan <span style="mso-tab-count: 1;"> </span>:<span style="mso-spacerun: yes;"> </span>Nyeri
berkurang sampai dengan hilang</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rencana Tindakan<span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Kaji karakteristik nyeri, lokasi,
frekfensi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ mengtahui tingkat nyeri sebagai
evaluasi untuk intervensi selanjutnya<br />
2. Kaji faktor penyebab timbul nyeri (takut , marah, cemas)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ dengan mengetahui faktor penyebab
nyeri menentukan tindakan untuk mengurangi nyeri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Ajarkan tehnik relaksasi tarik
nafas dalam</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ tehnik relaksasi dapat mengatsi
rasa nyeri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Kolaborasi dengan dokter untuk
pemberian analgetik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ analgetik efektif untuk mengatasi
nyeri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
2. Perubahan nutrisi kurang dari kebutuhan tubuh berhubungan dengan mual,
muntah dan tidak nafsu makan.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 3;"> </span>: Kebutuhsn nutrisi dapat terpenuhi
setelah dilakukan keperawatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hasil yang diharapkan <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Nutrisi klien terpenuhi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Mual berkurang sampai dengan
hilang.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rencana tindakan <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Hidangkan makanan dalam porsi
kecil tapi sering dan hangat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ Makanan yang hangat menambah
nafsu makan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Kaji kebiasaan makan klien.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ Jenis makanan yang disukai akan
membantu meningkatkan nafsu makan klien.<br />
3. Ajarkan teknik relaksasi yaitu tarik napas dalam.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ Tarik nafas dalam membantu untuk
merelaksasikan dan mengurangi mual.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Timbang berat badan bila
memungkinkan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ Untuk mengetahui kehilangan berat
badan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5. Kolaborasi dengan dokter untuk
pemberian vitamin</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ Mencegah kekurangan karena
penurunan absorsi vitamin larut dalam lemak </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
3. Gangguan mobilitas fisik yang berhubungan dengan gangguan pergerakan dan
kelemahan.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 2;"> </span>: Gangguan mobilitas fisik teratasi setelah dilakukan
tindakan keperawatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil <span style="mso-tab-count: 1;"> </span>: Pasien mendemonstrasikan tehnik / prilaku
yang memungkinkan dilakukannya kembali aktifitas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rencana tindakan :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Kaji derajat mobilisasi pasien
dengan menggunakan skala ketergantungan<br />
( 0-4 )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : seseorang dalam semua kategori
sama-sama mempunyai resiko kecelakaan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Letakkan pasien pada posisi
tertentu untuk menghindari kerusakan karena tekanan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Perubahan posisi yang teratur
meningkatkan sirkulasi pada seluruh tubuh.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Bantu untuk melakukan rentang
gerak</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Mempertahankan mobilisasi dan
fungsi sendi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Tingkatkan aktifitas dan
partisipasi dalam merawat diri sendiri sesuai kemampuan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Proeses penyembuhan yang
lambat sering kali menyertai trauma kepala,</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">keterlibatan pasien dalam perencanaan
dan keberhasilan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5. Berikan perawatan kulit dengan cermat,
masase dengan pelembab.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Meningkatkan sirkulasi dan
elastisitas kulit</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
4. Kerusakan komunikasi verbal yang berhubungan dengan kerusakan sirkulasi
serebral.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan : Klien dapat membuat metode
komunikasi dimana kebutuhan dapat di ekspresikan<br />
Kriteria Hasil :</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level2 lfo10; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Mengindikasikan pemahaman tentang
masalah komunikasi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level2 lfo10; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Membuat metode komunikasi dimana
kebutuhan dapat diekspresikan</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 42.55pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level2 lfo10; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Menggunakan sumber-sumber dengan
tepat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Intervensi :<br />
1. Kaji tipe/derajat disfungsi seperti pasien tidak tampak memahami kata atau
mangalami kesulitan berbicara atau membuat pengertian sendiri<br />
R/ : Membantu menentukan daerah dan derajat kerusakan serebral yang terjadi dan
kesulitan pasien dalam bebrapa atau seluruh tahap proses komunikasi.<br />
2. Perhatikan kesalahan dalam komunikasi dan berikan umpan balik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Pasien mungkin kehilangan
kemampuan untuk memantau ucapn yang keluar dan tidak menyadari bahwa komunikasi
yang diucapkan tidak nyata.<br />
3. Minta pasien untuk mengikuti perintah sederhana</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : menilai adanya kerusakan
motorik</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Katakan secara langsung pada pasien,
bicara perlahan dan tenang</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : menurunkan kebingungan/ansietas
selama proses komunikasi dan respon pada informasi yang lebih banyak pada satu
waktu tertentu. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
5. Gangguan harga diri berhubungan dengan ketergantungan, perubahan peran,
perubahan citra diri.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 2;"> </span>: Gangguan harga diri teratasi setelah dilakukan
tindakan keperawatan<br />
Kriteria Hasil <span style="mso-tab-count: 1;"> </span>: Klien dapat percaya diri
dengan keadaan penyakitnya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Intervensi <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Kaji respon, reaksi keluarga dan
pasien terhadap penyakit dan penanganannya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/: Untuk mempermudah dalam proses
pendekatan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. <span style="mso-spacerun: yes;"> </span>Kaji hubungan antara pasien dan anggota
keluarga dekat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/: Support keluarga membantu dalam
proses penyembuhan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Libatkan semua orang terdekat
dalam pendidikan dan perencanaan perawatan di rumah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Dapat memudahkan beban terhadap
penanganan dan adaptasi di rumah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Berikan waktu/dengarkan hal-hal
yang menjadi keluhan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/: Dukungan yang terus menerus akan
memudahkan dalam proses adaptasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
6. Kurang pengetahuan tentang kondisi dan penanganan penyakit berhubungan
dengan kurangnya informasi.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 2;"> </span>: Pengetahuan pasien bertambah mengenai kondisi dan
penanganan penyakit setelah dilakukan tindakan keperawatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil <span style="mso-tab-count: 1;"> </span>: Pasien mengerti penyebab ginjal dan komplikasinya.<br />
Rencana Keperawatan <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Kaji pemahaman pasien, keluarga
mengenai penyebab gagal ginjal dan penanganannya.<br />
R / : Instruksi dasar untuk penyuluhan lebih lanjut.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Jelaskan fungsi renal dan
konsekuensinya sesuai dengan tingkat pemahaman klien.<br />
R / : Menambah pengetahuan pasien.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Bantu pasien untuk
mengidentifikasi cara-cara memahami perubahan akibat penyakit.<br />
R / : Pasien dapat melihat bahwa kehidupannya tidak harus berubah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
7. Kecemasan berhubungan dengan rencana pembedahan</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 3;"> </span>: Kecemasan dapat diminimalkan setelah
dilakukan tindakan keperawatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hasil yang diharapkan <span style="mso-tab-count: 1;"> </span>: Kecemasan pasien berkurang</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rencana Tindakan <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Jelaskan setiap tindakan yang
akan dilakukan terhadap pasien<br />
R/ pasien kooperatif dalam segala tindakan dan mengurangi kecemasan pasien<br />
2. Beri kesempatan pada pasien untuk mengungkapkan perasaan akan<br />
ketakutannya<br />
R/ untuk mengurangi kecemasan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Evaluasi tingkat pemahaman pasien
/ orang terdekat tentang diagnosa medik<br />
R/ memberikan informasi yang perlu untuk memilih intervensi yang tepat<br />
4. Akui rasatakut/ masalah pasien dan dorong mengekspresikan perasaan<br />
R/ dukungan memampukan pasien memulai membuka/ menerima kenyataan penyakit dan
pengobatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Post
Operasi</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
1. Nyeri yang berhubungan dengan efek dari pembedahan.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 2;"> </span>: Nyeri berkurang sampai hilang setelah dilakukan
tindakan keperawatan<br />
Kriteria Hasil <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Pasien dapat menjalani aktivitas
tanpa merasa nyeri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Ekspresi wajah rileks</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Klien mendemonstrasikan
ketidaknyamananya hilang</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rencana Keperawatan <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Kaji tingkat nyeri (lokasi,
durasi, intensitas, kualitas) tiap 4 – 6 jam<br />
R/ : Sebagai indikator awal dalam menentukan intervensi berikutnya</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Kaji keadaan umum pasien dan TTV</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Sebagai indikator awal dalam
menentukan intervensi berikutnya</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Beri posisi yang menyenangkan
bagi pasien</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Untuk membantu pasien dalam
pengontrolan nyeri</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Beri waktu istrahat yang banyak
dan kurangi pengunjung sesuai keinginan pasien</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Dapat menurunkan ketidaknyamanan
fisik dan emosional</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5. Kolaborasi dengan dokter dalam
pemberian obat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Membantu dalam penyembuhan
pasien</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
2. Gangguan harga diri berhubungan dengan ketergantungan, perubahan peran,
perubahan citra diri.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan : Gangguan harga diri
teratasi setelah dilakuakn tindakan keperawatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil : Klien dapat percaya
diri dengan keadaan penyakitnya.<br />
Rencana keperawatan :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Kaji respon, reaksi keluarga dan
pasien terhadap penyakit dan penanganannya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Untuk mempermudah dalam proses
pendekatan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Kaji hubungan antara pasien dan
anggota keluarga dekat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Support keluarga membantu
dalam proses penyembuhan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Libatkan semua orang terdekat
dalam pendidikan dan perencanaan perawatan di rumah.<br />
R / : Dapat memudahkan beban terhadap penanganan dan adaptasi di rumah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Berikan waktu/dengarkan hal-hal
yang menjadi keluhan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Dukungan yang terus menerus
akan memudahkan dalam proses adaptasi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
3. Kurang pengetahuan tentang tumor otak yang berhubungan dengan ketidaktahuan
tentang sumber informasi</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 2;"> </span>: Informasi tentang perawatan diri dan status nutrisi
dipahami setalah dilakukan tindakan keperawatan selama 1 x 24 jam</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kriteria hasil <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Klien menyatakan pemahaman tentang
informasi yang diberikan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Klien menyatakan kesadaran dan
merencanakan perubahan pola perawatan diri<br />
Intervensi <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Kaji tingkat pengetahuan pasien</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Untuk mengetahui tingkat
pengetahuan dalam penerimaan informasi, sehingga dapat memberikan informasi
secara tepat</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Diskusikan hubungan tentang agen
penyebab terhadap penyakit Ca. Paru<br />
R/ : Memberikan pemahaman kepada pasien tentang hal-hal yang menjadi pencetus
penyakit</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Jelaskan tanda dan gejala
perforasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Gejala perforasi adalah nyeri
pada dada</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Jelaskan pentingnya lingkungan
tanpa stress</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Untuk mencegah peningkatan
stimulasi simpatis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5. Diskusikan tentang metode
pelaksanaan stress</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R/ : Cara penatalaksanaan stress :
relaksasi, latihan dan pengobatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dx
4 Kecemasan yang berhubungan dengan penyakit kronis dan masa depan yang tidak
pasti.</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan <span style="mso-tab-count: 2;"> </span>: Kecemaskan dapat diminimalkan setelah dilakukan
tindakan keperawatan<br />
Kriteria Hasil <span style="mso-tab-count: 1;"> </span>: Kecemasan berkurang.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Intervensi <span style="mso-tab-count: 1;"> </span>:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Mendengarkan keluhan klien dengan
sabar.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Menghadapi isu pasien dan
perlu dijelaskan dan membuka cara penyelesaiannya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Menjawab pertanyaan klien dan
keluarga dengan ramah.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Membuat pasien yakin dan
percaya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Mendorong klien dan keluarga
mencurahkan isi hati.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Membuat kepercayaan dan
menurunkan kesalahan persepsi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Menggunakan teknik komunikasi
terapeutik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Menjalin hubungan saling
percaya pasien.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5. Berikan kenyamanan fisik pasien.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">R / : Ini sulit untuk menerima dengan
isu emosi bila pengalaman</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">ekstrem/ketidaknyamanan fisik
menetap.</span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Daftar Pustaka</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">A.K. Muda,
Ahmad. 2003. <i style="mso-bidi-font-style: normal;">Kamus Lengkap Kedokteran Edisi
Revisi</i>. Jakarta : Gitamedia Press.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Carpenito,
Lynda Juall RN.1999. Diagnosa dan Rencana Keperawatan Ed 3. Jakarta : Media
Aesculappius.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Purnawan
Ajunadi, Atiek S.seomasto, Husna Ametz,(1982). Kapita Selekta Kedokteran. Jakarta
: Media Aesculapius</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 63.8pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.8pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Doenges,
Marilynn E. 1999. Rencana Asuhan Keperawatan. Edisi 3. Jakarta : EGC</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0tag:blogger.com,1999:blog-2019307917234147775.post-40647805326773908612011-11-10T06:37:00.001-08:002011-11-10T06:37:47.820-08:00askep karsinoma buli<!--[if !mso]>
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<div class="MsoTitle" style="line-height: 150%;">
ASUHAN KEPERAWATAN </div>
<div class="MsoTitle" style="line-height: 150%;">
PADA KLIEN DENGAN KARSINOMA
BULI-BULI</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
A. TINJAUAN TEORI</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l36 level1 lfo52; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span>PENGERTIAN</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt;">
Tomor buli-buli
adalah tumor yang didapatkan dalam buli-buli.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; mso-list: l36 level1 lfo52; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";"> </span></span>ISIDEN</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt;">
Yang paling
sering dijangkiti kanker dari alat perkemihan adalah Buli-buli. Kanker
Buli-buli terjadi tiga kali lebih banyak pada pria dibandingkan pada wanita,
dan tumor-tumor multipel juga lebih sering, kira-kira 25% klien mempunyai lebih
dari satu lesi pada satu kali dibuat diagnosa. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; mso-list: l36 level1 lfo52; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">III.<span style="font: 7.0pt "Times New Roman";"> </span></span>KLASIFIKASI</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l36 level2 lfo52; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Staging dan klasifikasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Klasifikasi
DUKE-MASINA, JEWTT dengan modifikasi STRONG-MARSHAL untuk menentukan operasi
atau observasi :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>T = pembesaran local tumor primer, ditentukan melalui :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
Pemeriksaan
klinis, uroghrafy, cystoscopy, pemeriksaan bimanual di bawah anestesi umum dan
biopsy atau transurethral reseksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
Tis = carcinoma
insitu (pre invasive Ca)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
Tx = cara
pemeriksaan untuk menetapkan penyebaran tumor, tak dapat dilakukan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
To =
tanda-tanda tumor primer tidak ada</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
T1. pada
pemeriksaan bimanual didapatkan masa yang bergerak</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
T2 = pada
pemeriksaan bimanual<span style="mso-spacerun: yes;"> </span>ada indurasi
daripada dinding buli-buli.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
T3 = pada
pemeriksaan bimanual indurasi atau masa nodular yang bergerak bebeas dapat
diraba di buli-buli.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
T3a = invasi
otot yang lebih dalam</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
T3b= perluasan
lewat dinding buli-buli</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
T4 = Tumor
sudah melewati struktur sebelahnya</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
T4a= tumor
mengadakan invasi ke dalam prostate, uterus vagina</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
T4b= tumor
sudah melekat pada dinding pelvis atau infiltrasi ke dalam abdomen. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>N = Pembesaran secara klinis untuk pemebesaran kelenjar
limfe</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
pemeriksaan
kinis, lympgraphy, urography, operative</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
Nx = minimal
yang ditetapkan kel. Lymfe regional tidak dapat ditemukan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
No = tanpa
tanda-tanda pemebsaran kelenjar lymfe regional</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
N1 = pemebsaran
tunggal kelenjar lymfe regional yang homolateral</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
N2 = pembesaran
kontralateral atau bilateral atau kelenjar lymfe regional yang multiple</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
N3 = masa yang
melekat pada dinding pelvis dengan rongga yang bebeas antaranya dan tumor</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
N4 =
pemebesaran lkelenjar lymfe juxta regional</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>M = metastase jauh termasuk pemebesaran kelenjar limfe
yang jauh</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
Pemeriksaan
klinis , thorax foto, dan test biokimia</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
Mx = kebutuhan
cara pemeriksaan minimal untuk menetapkan adanya metastase jauh, tak dapat
dilaksanakan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
M1 = adanya
metastase jauh </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
M1a= adanya
metastase yang tersembunyi pada test-test biokimia</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
M1b= metastase
tunggal dalam satu organ yang tunggal</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
M1c= metastase
multiple dalam satu terdapat organ yang multiple</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt;">
M1d= metastase
dalam organ yang multiple</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l36 level2 lfo52; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>type dan lokasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Type tumor
didasarkan pada type selnya, tingkat anaplasia dan invasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>efidermoid Ca, kira-kira 5% neoplasma buli-buli
–squamosa cell., anaplastik, invasi yang dalam dan cepat metastasenya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Adeno Ca, sangat jarang dan sering muncul pada bekas
urachus</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Rhabdomyo sarcoma, sering terjadi pada anak-anak
laki-laki (adolescent), infiltasi, metastase cepat dan biasanya fatal</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Primary Malignant lymphoma, neurofibroma dan
pheochromacytoma, dapat menimbulkan serangan hipertensi selama kencing</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 65.45pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ca dari pada kulit, melanoma, lambung, paru dan mamma
mungkin mengadakan metastase ke buli-buli, invasi ke buli-buli oleh
endometriosis dapat terjadi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 99.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; mso-list: l36 level1 lfo52; tab-stops: list 57.85pt; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">IV.<span style="font: 7.0pt "Times New Roman";"> </span></span>GEJALA
KLINIS</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l13 level4 lfo73; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Kencing campur dara yang intermitten</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l13 level4 lfo73; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Merasa panas waktu kencing</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l13 level4 lfo73; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Merasa ingin kencing</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l13 level4 lfo73; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Sering kencing terutama malam hari dan pada fase
selanjutnya sukar kencing</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l13 level4 lfo73; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri suprapubik yang konstan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l13 level4 lfo73; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Panas badan dan merasa lemah</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l13 level4 lfo73; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri pinggang karena tekanan saraf</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l13 level4 lfo73; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Nyeri pda satu sisi karena hydronephrosis</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="page-break-before: always;" />
</span>
<div class="MsoNormal" style="line-height: 150%;">
PATOFISOILOGI</div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt; text-align: center;">
<span style="height: 51px; left: 0px; margin-left: 293px; margin-top: 16px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251651072;"><img height="51" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="12" /></span>BULI-BULI</div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt; text-align: center;">
<span style="height: 43px; left: 0px; margin-left: 311px; margin-top: 17px; mso-ignore: vglayout; position: absolute; width: 215px; z-index: 251654144;"><img height="43" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="215" /></span><span style="height: 27px; left: 0px; margin-left: 306px; margin-top: 17px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251653120;"><img height="27" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="12" /></span><span style="height: 31px; left: 0px; margin-left: 85px; margin-top: 17px; mso-ignore: vglayout; position: absolute; width: 228px; z-index: 251652096;"><img height="31" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="228" /></span>Ca Buli-Buli</div>
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<br /></div>
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<tbody>
<tr style="mso-yfti-lastrow: yes;">
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<span style="height: 51px; left: 0px; margin-left: 81px; margin-top: 21px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251655168;"><img height="51" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="12" /></span>Ulserasi</div>
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<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Infeksi
sekunder :</div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-align: center; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>panas waktu kencing</div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-align: center; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>merasa panas dan tubuh lemah</div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-align: center; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>kencing campur darah</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 154.8pt;" valign="top" width="206">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="height: 39px; left: 0px; margin-left: 87px; margin-top: 21px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251656192;"><img height="39" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image006.gif" width="12" /></span>Metastase</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="height: 63px; left: 0px; margin-left: 87px; margin-top: 14px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251657216;"><img height="63" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image007.gif" width="12" /></span>Invasi pada bladder</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Retensio
urine :</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
-
sulit/sukar kenicing</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 154.8pt;" valign="top" width="206">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="height: 27px; left: 0px; margin-left: 80px; margin-top: 21px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251658240;"><img height="27" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image008.gif" width="12" /></span>Oklusi ureter/pelvic renal</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="height: 39px; left: 0px; margin-left: 80px; margin-top: 14px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251659264;"><img height="39" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image006.gif" width="12" /></span>Refluks</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Hydronephrosis</div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-align: center; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>nyeri suprapubic</div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-align: center; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="height: 39px; left: 0px; margin-left: 80px; margin-top: 11px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251660288;"><img height="39" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image009.gif" width="12" /></span>nyeri pinggang</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Ginjal
membesar</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt;">
<span style="height: 62px; left: 0px; margin-left: 231px; margin-top: 12px; mso-ignore: vglayout; position: absolute; width: 149px; z-index: 251661312;"><img height="62" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image010.gif" width="149" /></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt; text-align: center;">
<span style="height: 67px; left: 0px; margin-left: 311px; margin-top: 13px; mso-ignore: vglayout; position: absolute; width: 204px; z-index: 251664384;"><img height="67" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image011.gif" width="204" /></span><span style="height: 75px; left: 0px; margin-left: 306px; margin-top: 13px; mso-ignore: vglayout; position: absolute; width: 12px; z-index: 251663360;"><img height="75" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image012.gif" width="12" /></span><span style="height: 67px; left: 0px; margin-left: 84px; margin-top: 13px; mso-ignore: vglayout; position: absolute; width: 229px; z-index: 251662336;"><img height="67" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image013.gif" width="229" /></span>Penatalaksanaan</div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 9.35pt; text-align: center;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="mso-yfti-lastrow: yes;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 154.75pt;" valign="top" width="206">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Operasi</div>
<div class="MsoNormal" style="line-height: 150%;">
Kecemasan</div>
<div class="MsoNormal" style="line-height: 150%;">
Takut</div>
<div class="MsoNormal" style="line-height: 150%;">
Kurang pengetahuan</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 154.8pt;" valign="top" width="206">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Radiology</div>
<div class="MsoNormal" style="line-height: 150%;">
Defifsit ekonomi</div>
<div class="MsoNormal" style="line-height: 150%;">
Tidak adequatnya terapi</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 154.8pt;" valign="top" width="206">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Chemotherapy</div>
<div class="MsoNormal" style="line-height: 150%;">
Tidak adequatnya terapi</div>
<div class="MsoNormal" style="line-height: 150%;">
Efek samping chemotherapy</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>panas tubuh dan lemah</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>nafsu makan menurun</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>intoleransi aktivitas</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>depresi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l70 level1 lfo55; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>konsep diri</div>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<div class="WordSection2">
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; mso-list: l36 level1 lfo52; tab-stops: list 57.85pt; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">V.<span style="font: 7.0pt "Times New Roman";">
</span></span>PENATALAKSANAAN</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt;">
a. Pemeriksaan
penunjang</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level2 lfo52; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Laboratorium</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt;">
Hb menurun oleh
karena kehilangan darah, infeksi, uremia, gros atau micros hematuria</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt;">
Lukositosis bila
terjadi infeksi sekunder dan terdapat pus dan bakteri dalam urine</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt;">
RFT normal</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt;">
Lymphopenia (N =
1490-2930)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level2 lfo52; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Radiology</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level4 lfo52; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>excretory urogram biasanya normal, tapi mungkin
dapat menunjukkan tumornya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level4 lfo52; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Retrograde cystogram dapat menunjukkan tumor</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level4 lfo52; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Fractionated cystogram adanya invasi tomor dalam
dinding buli-buli</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level4 lfo52; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Angography untuk mengetahui adanya metastase
lewat pembuluh lymphe</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level2 lfo52; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Cystocopy dan biopsy</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level4 lfo52; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>cystoscopy hamper selalu menghasilkan tumor</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level4 lfo52; text-indent: -18.0pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Biopasi dari pada lesi selalu dikerjakan secara
rutin.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level2 lfo52; tab-stops: list 72.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>cystologi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt;">
Pengecatan
sieman/papanicelaou pada sediment urine terdapat transionil cel daripada tumor</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt;">
b. Terapi </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Operasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level5 lfo52; tab-stops: list 76.5pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a)<span style="font: 7.0pt "Times New Roman";">
</span></span>reseksi tranurethral untuk single/multiple papiloma</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level5 lfo52; tab-stops: list 76.5pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b)<span style="font: 7.0pt "Times New Roman";">
</span></span>Dilakukan pada stage 0,A,B1 dan grade I-II-low grade</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 74.8pt; mso-list: l36 level5 lfo52; tab-stops: list 76.5pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c)<span style="font: 7.0pt "Times New Roman";">
</span></span>Total cystotomy dengan pegangkatan kel. Prostate dan
urinary diversion untuk :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l47 level4 lfo56; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>transurethral cel tumor pada grade 2 atau lebih</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l47 level4 lfo56; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>aquamosa cal Ca pada stage B-C</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Radioterapy</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l41 level4 lfo57; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Diberikan pada tumor yang radiosensitive seperti
undifferentiated pada grade III-IV dan stage B2-C.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l41 level4 lfo57; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="font-family: "Abadi MT Condensed","sans-serif"; mso-bidi-font-family: "Abadi MT Condensed"; mso-fareast-font-family: "Abadi MT Condensed";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span>RAdiasi diberikan sebelum operasi selama 3-4
minggu, dosis 3000-4000 Rads. Penderita dievaluasi selam 2-4 minggu dengan
iinterval cystoscopy, foto thoraks dan IVP, kemudian 6 minggu setelah radiasi
direncanakan operasi. Post operasi radiasi tambahan 2000-3000 Rads selam 2-3
minggu.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l36 level3 lfo52; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Chemoterapi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt;">
Obat-obat anti
kanker :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l36 level6 lfo52; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>citral, 5 fluoro urasil</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l36 level6 lfo52; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>topical chemotherapy yaitu Thic-TEPA,<span style="mso-spacerun: yes;"> </span>Chemotherapy merupakan paliatif. 5-
Fluorouracil (5-FU) dan doxorubicin (adriamycin) merupakan bahan yang paling
sering dipakai. Thiotepa dapat diamsukkan ke dalam Buli-buli sebagai pengobatan
topikal. Klien dibiarkan menderita dehidrasi 8 sampai 12 jam sebelum pengobatan
dengan theotipa dan obat diabiarkan dalam Buli-buli selama dua jam.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; mso-list: l36 level1 lfo52; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">VI.<span style="font: 7.0pt "Times New Roman";"> </span></span>PROGNOSIS</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt;">
Penemuan dan
pemeriksaan dini, prognosisnya baik, tetapi bila sudah lama dan adanya
metastesi ke organ lebih dalam dan lainnya prognosisnya jelek.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; mso-list: l36 level1 lfo52; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">VII.<span style="font: 7.0pt "Times New Roman";"> </span></span>KOMPLIKASI</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l36 level6 lfo52; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Infeksi sekunder bil atumor mengalami ulserasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l36 level6 lfo52; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Retensi urine bil atumor mengadakan invasi ke bladder
neck</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 87.3pt; mso-list: l36 level6 lfo52; tab-stops: list 87.3pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Hydronephrosis oleh karena ureter menglami oklusi</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
B. KONSEP KEPERAWATAN</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l36 level7 lfo52; tab-stops: list 22.5pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengkajian</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.05pt; mso-list: l79 level1 lfo54; tab-stops: list 46.05pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Identitas</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Yang paling
sering dijangkiti kanker dari alat perkemihan adalah Buli-buli. Kanker
Buli-buli terjadi tiga kali lebih banyak pada pria dibandingkan pada wanita,
dan tumor-tumor multipel juga lebih sering, kira-kira 25% klien mempunyai lebih
dari satu lesi pada satu kali dibuat diagnosa. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.05pt; mso-list: l79 level1 lfo54; tab-stops: list 46.05pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat keperawatan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 47.45pt;">
Keluhan
penderita yang utama adalah mengeluh kencing darah yang intermitten, merasa
panas waktu kening. Merasa ingin kencing, sering kencing terutama malam hari
dan pada fase selanjutnya sukar kencing, nyeri suprapubik yang konstan, panas
badan dan merasa lemah, nyeri pinggang karena tekanan saraf, dan nyeri pada
satu sisi karena hydronephrosis</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.05pt; mso-list: l79 level1 lfo54; tab-stops: list 46.05pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemeriksaan fisik dan klinis</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<b style="mso-bidi-font-weight: normal;">Inspeksi </b>, tampak warna kencing campur
darah, pemebesaran suprapubic bil atumor sudah bear.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<b style="mso-bidi-font-weight: normal;">Palpasi,</b> teraba tumor 9masa)
suprapubic, pmeriksaan bimaual teraba tumpr pada dasar buli-buli dengan bantuan
general anestesi baik waktu VT atau RT.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.05pt; mso-list: l79 level1 lfo54; tab-stops: list 46.05pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemeriksaan penunjang</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Lihat kosep
dasar.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l36 level7 lfo52; tab-stops: list 22.5pt; text-indent: -21.85pt;">
<span style="mso-bidi-font-weight: bold;"><span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="mso-bidi-font-weight: bold;">Perencanaan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Cemas / takut berhubungan dengan situasi krisis
(kanker), perubahan kesehatan, sosio ekonomi, peran dan fungsi, bentuk
interaksi, persiapan kematian, pemisahan dengan keluarga ditandai dengan
peningkatan tegangan, kelelahan, mengekspresikan kecanggungan peran, perasaan
tergantung, tidak adekuat kemampuan menolong diri, stimulasi simpatetik.</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l37 level1 lfo74; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien dapat mengurangi rasa cemasnya</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l37 level1 lfo74; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Rileks dan dapat melihat dirinya secara obyektif.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l37 level1 lfo74; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menunjukkan koping yang efektif serta mampu
berpartisipasi dalam pengobatan.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 22.65pt; mso-list: l34 level1 lfo19; tab-stops: list 27.35pt; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tentukan pengalaman klien sebelumnya terhadap
penyakit yang dideritanya.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 22.65pt; mso-list: l34 level1 lfo19; tab-stops: list 27.35pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan informasi tentang prognosis secara akurat.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 22.65pt; mso-list: l34 level1 lfo19; tab-stops: list 27.35pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Beri kesempatan pada klien untuk mengekspresikan rasa
marah, takut, konfrontasi. Beri informasi dengan emosi wajar dan ekspresi
yang sesuai.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 22.65pt; mso-list: l34 level1 lfo19; tab-stops: list 27.35pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Jelaskan pengobatan, tujuan dan efek samping. Bantu
klien mempersiapkan diri dalam pengobatan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 22.65pt; mso-list: l34 level1 lfo19; tab-stops: list 27.35pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Catat koping yang tidak efektif seperti kurang
interaksi sosial, ketidak berdayaan dll.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 4.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 4.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 22.65pt; mso-list: l34 level1 lfo19; tab-stops: list 27.35pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan untuk mengembangkan interaksi dengan support
system.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 22.65pt; mso-list: l34 level1 lfo19; tab-stops: list 27.35pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan lingkungan yang tenang dan nyaman.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 4.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 22.65pt; mso-list: l34 level1 lfo19; tab-stops: list 27.35pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pertahankan kontak dengan klien, bicara dan sentuhlah
dengan wajar.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 20.3pt; mso-list: l31 level1 lfo20; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Data-data mengenai pengalaman klien sebelumnya akan
memberikan dasar untuk penyuluhan dan menghindari adanya duplikasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 20.3pt; mso-list: l31 level1 lfo20; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemberian informasi dapat membantu klien dalam
memahami proses penyakitnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 20.3pt; mso-list: l31 level1 lfo20; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Dapat menurunkan kecemasan klien.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 20.3pt; mso-list: l31 level1 lfo20; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Membantu klien dalam memahami kebutuhan untuk
pengobatan dan efek sampingnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 20.3pt; mso-list: l31 level1 lfo20; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengetahui dan menggali pola koping klien serta
mengatasinya/memberikan solusi dalam upaya meningkatkan kekuatan dalam
mengatasi kecemasan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 20.3pt; mso-list: l31 level1 lfo20; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Agar klien memperoleh dukungan dari orang yang
terdekat/keluarga.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 20.3pt; mso-list: l31 level1 lfo20; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberikan kesempatan pada klien untuk
berpikir/merenung/istirahat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 20.3pt; mso-list: l31 level1 lfo20; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mendapatkan kepercayaan diri dan keyakinan bahwa
dia benar-benar ditolong.</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Nyeri (akut) berhubungan dengan proses penyakit
(penekanan/kerusakan jaringan syaraf, infiltrasi sistem suplay syaraf,
obstruksi jalur syaraf, inflamasi), efek samping therapi kanker ditandai dengan
klien mngatakan nyeri, klien sulit tidur, tidak mampu memusatkan perhatian,
ekspresi nyeri, kelemahan.</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l63 level1 lfo75; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mampu mengontrol rasa nyeri melalui aktivitas</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l63 level1 lfo75; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Melaporkan nyeri yang dialaminya</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l63 level1 lfo75; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengikuti program pengobatan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l63 level1 lfo75; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mendemontrasikan tehnik relaksasi dan pengalihan rasa nyeri
melalui aktivitas yang mungkin.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l43 level1 lfo58; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tentukan riwayat nyeri, lokasi, durasi dan intensitas.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l43 level1 lfo58; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Evaluasi therapi: pembedahan, radiasi, khemotherapi,
biotherapi, ajarkan klien dan keluarga tentang cara menghadapinya</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l43 level1 lfo58; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan pengalihan seperti reposisi dan aktivitas
menyenangkan seperti mendengarkan musik atau nonton TV</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l43 level1 lfo58; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menganjurkan tehnik penanganan stress (tehnik
relaksasi, visualisasi, bimbingan), gembira, dan berikan sentuhan
therapeutik.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l43 level1 lfo58; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Evaluasi nyeri, berikan pengobatan bila perlu.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l43 level1 lfo58; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Diskusikan penanganan nyeri dengan dokter dan juga
dengan klien</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l43 level1 lfo58; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan analgetik sesuai indikasi seperti morfin,
methadone, narkotik dll</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l38 level1 lfo22; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberikan informasi yang diperlukan untuk
merencanakan asuhan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l38 level1 lfo22; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Untuk mengetahui terapi yang dilakukan sesuai atau
tidak, atau malah menyebabkan komplikasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -2.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l38 level1 lfo22; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Untuk meningkatkan kenyamanan dengan mengalihkan
perhatian klien dari rasa nyeri.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -2.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l38 level1 lfo22; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Meningkatkan kontrol diri atas efek samping dengan
menurunkan stress dan ansietas.</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l38 level1 lfo22; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Untuk mengetahui efektifitas penanganan nyeri,
tingkat nyeri dan sampai sejauhmana klien mampu menahannya serta untuk
mengetahui kebutuhan klien akan obat-obatan anti nyeri.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l38 level1 lfo22; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Agar terapi yang diberikan tepat sasaran.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l38 level1 lfo22; tab-stops: list 21.85pt; text-indent: -24.55pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Untuk mengatasi nyeri.</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Gangguan nutrisi (kurang dari kebutuhan tubuh)
berhubungan dengan hipermetabolik yang berhubungan dengan kanker, konsekwensi
khemotherapi, radiasi, pembedahan (anoreksia, iritasi lambung, kurangnya rasa
kecap, nausea), emotional distress, fatigue, ketidakmampuan mengontrol nyeri
ditandai dengan klien mengatakan intake tidak adekuat, hilangnya rasa kecap,
kehilangan selera, berat badan turun sampai 20% atau lebih dibawah ideal,
penurunan massa otot dan lemak subkutan, konstipasi, abdominal cramping.</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l11 level1 lfo76; tab-stops: list 21.85pt left 37.4pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien menunjukkan berat badan yang stabil, hasil lab
normal dan tidak ada tanda malnutrisi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l11 level1 lfo76; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menyatakan pengertiannya terhadap perlunya intake yang
adekuat</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l11 level1 lfo76; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berpartisipasi dalam penatalaksanaan diet yang
berhubungan dengan penyakitnya</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitor intake makanan setiap hari, apakah klien
makan sesuai dengan kebutuhannya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Timbang dan ukur berat badan, ukuran triceps serta
amati penurunan berat badan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji pucat, penyembuhan luka yang lambat dan
pembesaran kelenjar parotis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan klien untuk mengkonsumsi makanan tinggi
kalori dengan intake cairan yang adekuat. Anjurkan pula makanan kecil untuk
klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kontrol faktor lingkungan seperti bau busuk atau
bising. Hindarkan makanan yang terlalu manis, berlemak dan pedas.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 4.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ciptakan suasana makan yang menyenangkan misalnya
makan bersama teman atau keluarga.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan tehnik relaksasi, visualisasi, latihan
moderate sebelum makan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan komunikasi terbuka tentang problem anoreksia
yang dialami klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kolaboratif</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">j.<span style="font: 7.0pt "Times New Roman";">
</span></span>Amati studi laboraturium seperti total limposit,
serum transferin dan albumin</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">k.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan pengobatan sesuai indikasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">l.<span style="font: 7.0pt "Times New Roman";">
</span></span>Phenotiazine, antidopaminergic, corticosteroids,
vitamins khususnya A,D,E dan B6, antacida</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l58 level1 lfo59; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">m.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pasang pipa nasogastrik untuk memberikan makanan
secara enteral, imbangi dengan infus.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberikan informasi tentang status gizi klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberikan informasi tentang penambahan dan penurunan
berat badan klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menunjukkan keadaan gizi klien sangat buruk.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kalori merupakan sumber energi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah mual muntah, distensi berlebihan, dispepsia
yang menyebabkan penurunan nafsu makan serta mengurangi stimulus berbahaya
yang dapat meningkatkan ansietas.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Agar klien merasa seperti berada dirumah sendiri.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Untuk menimbulkan perasaan ingin makan/membangkitkan
selera makan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Agar dapat diatasi secara bersama-sama (dengan ahli
gizi, perawat dan klien).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";">
</span></span>Untuk mengetahui/menegakkan terjadinya gangguan
nutrisi sebagi akibat perjalanan penyakit, pengobatan dan perawatan terhadap
klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">j.<span style="font: 7.0pt "Times New Roman";">
</span></span>Membantu menghilangkan gejala penyakit, efek samping
dan meningkatkan status kesehatan klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l22 level1 lfo25; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">k.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mempermudah intake makanan dan minuman dengan hasil
yang maksimal dan tepat sesuai kebutuhan.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kurangnya pengetahuan tentang penyakit, prognosis dan
pengobatan berhubungan dengan kurangnya informasi, misinterpretasi,
keterbatasan kognitif ditandai dengan sering bertanya, menyatakan masalahnya,
pernyataan miskonsepsi, tidak akurat dalam mengikiuti intruksi/pencegahan
komplikasi.</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l19 level1 lfo77; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien dapat mengatakan secara akurat tentang diagnosis
dan pengobatan pada ting-katan siap.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l19 level1 lfo77; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengikuti prosedur dengan baik dan menjelaskan tentang
alasan mengikuti prosedur<span style="mso-spacerun: yes;"> </span>tersebut.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l19 level1 lfo77; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mempunyai inisiatif dalam perubahan gaya hidup dan
berpartisipasi dalam pengo-<span style="mso-spacerun: yes;"> </span>batan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l19 level1 lfo77; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Bekerjasama dengan pemberi informasi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l24 level1 lfo60; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Review pengertian klien dan keluarga tentang
diagnosa, pengobatan dan akibatnya.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l24 level1 lfo60; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tentukan persepsi klien tentang kanker dan
pengobatannya, ceritakan pada klien tentang pengalaman klien lain yang
menderita kanker.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l24 level1 lfo60; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Beri informasi yang akurat dan faktual. Jawab
pertanyaan secara spesifik, hindarkan informasi yang tidak diperlukan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l24 level1 lfo60; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan bimbingan kepada klien/keluarga sebelum
mengikuti prosedur pengobatan, therapy yang lama, komplikasi. Jujurlah pada
klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l24 level1 lfo60; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan klien untuk memberikan umpan balik verbal
dan mengkoreksi miskonsepsi tentang penyakitnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l24 level1 lfo60; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Review klien /keluarga tentang pentingnya status
nutrisi yang optimal.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l24 level1 lfo60; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan klien untuk mengkaji membran mukosa mulutnya
secara rutin, perhatikan adanya eritema, ulcerasi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 4.65pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l24 level1 lfo60; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan klien memelihara kebersihan kulit dan
rambut.</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l60 level1 lfo61; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menghindari adanya duplikasi dan pengulangan terhadap
pengetahuan klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l60 level1 lfo61; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memungkinkan dilakukan pembenaran terhadap kesalahan
persepsi dan konsepsi serta kesalahan pengertian.</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l60 level1 lfo61; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Membantu klien dalam memahami proses penyakit.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l60 level1 lfo61; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Membantu klien dan keluarga dalam membuat keputusan
pengobatan.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l60 level1 lfo61; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengetahui sampai sejauhmana pemahaman klien dan
keluarga mengenai penyakit klien.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l60 level1 lfo61; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Meningkatkan pengetahuan klien dan keluarga mengenai
nutrisi yang adekuat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l60 level1 lfo61; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengkaji perkembangan proses-proses penyembuhan dan
tanda-tanda infeksi serta masalah dengan kesehatan mulut yang dapat
mempengaruhi intake makanan dan minuman.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l60 level1 lfo61; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Meningkatkan integritas kulit dan kepala.</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Resiko tinggi kerusakan membran mukosa mulut
berhubungan dengan efek samping kemotherapi dan radiasi/radiotherapi.</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l15 level1 lfo78; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Membrana mukosa tidak menunjukkan kerusakan, terbebas
dari inflamasi dan ulcerasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l15 level1 lfo78; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mengungkapkan faktor penyebab secara verbal.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l15 level1 lfo78; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mampu mendemontrasikan tehnik mempertahankan/menjaga
kebersihan rongga mulut.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji kesehatan gigi dan mulut pada saat pertemuan
dengan klien dan secara periodik.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 4.65pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji rongga mulut setiap hari, amati perubahan mukosa
membran. Amati tanda terbakar di mulut, perubahan suara, rasa kecap,
kekentalan ludah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Diskusikan dengan klien tentang metode pemeliharan
oral hygine.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Intruksikan perubahan pola diet misalnya hindari
makanan panas, pedas, asam, hindarkan makanan yang keras.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Amati dan jelaskan pada klien tentang tanda
superinfeksi oral.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kolaboratif.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Konsultasi dengan dokter gigi sebelum kemotherapi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan obat sesuai indikasi, analgetik, topikal
lidocaine,<span style="mso-spacerun: yes;"> </span>antimikrobial mouthwash</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";">
</span></span>preparation.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l73 level1 lfo62; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">j.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kultur lesi oral.</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l27 level1 lfo63; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengkaji perkembangan proses penyembuhan dan
tanda-tanda infeksi memberikan informasi penting untuk mengembangkan rencana
keperawatan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l27 level1 lfo63; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Masalah dengan kesehatan mulut dapat mempengaruhi
pemasukan makanan dan minuman.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l27 level1 lfo63; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencari alternatif lain mengenai pemeliharaan mulut
dan gigi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l27 level1 lfo63; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah rasa tidak nyaman dan iritasi lanjut pada
membran mukosa.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.3pt; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l27 level1 lfo63; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Agar klien mengetahui dan segera memberitahu bila ada
tanda-tanda tersebut.</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l27 level1 lfo63; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Meningkatkan
kebersihan dan kesehatan gigi dan gusi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l27 level1 lfo63; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tindakan/terapi yang dapat menghilangkan nyeri,
menangani infeksi dalam rongga mulut/infeksi sistemik.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l27 level1 lfo63; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Untuk mengetahui jenis kuman sehingga dapat diberikan
terapi antibiotik yang tepat.</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span>Resiko tinggi kurangnya volume cairan berhubungan
dengan output yang tidak normal (vomiting, diare), hipermetabolik, kurangnya
intake</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%;">
Klien menunjukkan keseimbangan
cairan dengan tanda vital normal, membran mukosa normal, turgor kulit bagus,
capilarry ferill normal, urine output normal.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitor intake dan output termasuk keluaran yang
tidak<span style="mso-spacerun: yes;"> </span>normal seperti emesis, diare,
drainase luka. Hitung keseimbangan selama 24 jam.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Timbang berat badan jika diperlukan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitor vital signs. Evaluasi pulse peripheral,
capilarry refil.</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji turgor kulit dan keadaan membran mukosa. Catat
keadaan kehausan pada klien.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan intake cairan samapi 3000 ml per hari sesuai
kebutuhan individu.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Observasi kemungkinan perdarahan seperti perlukaan
pada membran mukosa, luka bedah, adanya ekimosis dan pethekie.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindarkan trauma dan tekanan yang berlebihan pada
luka bedah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kolaboratif </div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan cairan IV bila diperlukan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">j.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan therapy antiemetik.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l40 level1 lfo64; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">k.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitor hasil laboratorium : Hb, elektrolit, albumin</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pemasukan oral yang tidak adekuat dapat menyebabkan
hipovolemia.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Dengan memonitor berat badan dapat diketahui bila ada
ketidakseimbangan cairan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tanda-tanda hipovolemia segera diketahui dengan
adanya takikardi, hipotensi dan suhu tubuh yang meningkat berhubungan dengan
dehidrasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Dengan mengetahui tanda-tanda dehidrasi dapat
mencegah terjadinya hipovolemia.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 1.6pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memenuhi kebutuhan cairan yang kurang.</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Segera diketahui adanya perubahan keseimbangan volume
cairan.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 1.6pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah terjadinya perdarahan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 1.6pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 1.6pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memenuhi kebutuhan cairan yang kurang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah/menghilangkan mual muntah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l56 level1 lfo65; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">j.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengetahui perubahan yang terjadi.</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span>Resiko tinggi infeksi berhubungan dengan tidak
adekuatnya pertahanan tubuh sekunder dan sistem imun (efek
kemotherapi/radiasi), malnutrisi, prosedur invasif</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l23 level1 lfo79; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mampu mengidentifikasi dan berpartisipasi dalam
tindakan pecegahan infeksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l23 level1 lfo79; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tidak menunjukkan tanda-tanda infeksi dan penyembuhan
luka berlangsung normal.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l57 level1 lfo66; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Cuci tangan sebelum melakukan tindakan. Pengunjung
juga dianjurkan melakukan hal yang sama.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l57 level1 lfo66; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Jaga personal hygine klien dengan baik.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l57 level1 lfo66; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitor temperatur.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l57 level1 lfo66; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji semua sistem untuk melihat tanda-tanda infeksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l57 level1 lfo66; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Hindarkan/batasi prosedur invasif dan jaga aseptik
prosedur.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l57 level1 lfo66; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kolaboratif.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l57 level1 lfo66; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Monitor CBC, WBC, granulosit, platelets.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l57 level1 lfo66; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan antibiotik bila diindikasikan.</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l5 level1 lfo67; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah terjadinya infeksi silang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l5 level1 lfo67; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menurunkan/mengurangi adanya organisme hidup.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l5 level1 lfo67; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Peningkatan suhu merupakan tanda terjadinya infeksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l5 level1 lfo67; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah/mengurangi terjadinya resiko infeksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l5 level1 lfo67; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah terjadinya infeksi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l5 level1 lfo67; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Segera dapat diketahui apabila terjadi infeksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l5 level1 lfo67; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Adanya indikasi yang jelas sehingga antibiotik yang
diberikan dapat mengatasi organisme penyebab infeksi.</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span>Resiko tinggi gangguan fungsi seksual berhubungan
dengan deficit pengetahuan/keterampilan tentang alternatif respon terhadap
transisi kesehatan, penurunan fungsi/struktur tubuh, dampak pengobatan.</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l16 level1 lfo80; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien dapat mengungkapkan pengertiannya terhadap efek
kanker dan therapi terhadap<span style="mso-spacerun: yes;"> </span>seksualitas</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l16 level1 lfo80; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mempertahankan aktivitas seksual dalam batas kemampuan.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l53 level1 lfo68; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Diskusikan dengan klien dan keluarga tentang proses
seksualitas dan reaksi serta hubungannya dengan penyakitnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l53 level1 lfo68; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan advise tentang akibat pengobatan terhadap
seksualitasnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l53 level1 lfo68; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan privacy kepada klien dan pasangannya.<span style="mso-spacerun: yes;"> </span>Ketuk pintu sebelum masuk.</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l75 level1 lfo69; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Meningkatkan ekspresi seksual dan meningkatkan
komunikasi terbuka antara klien dengan pasangannya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l75 level1 lfo69; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Membantu klien dalam mengatasi masalah seksual<span style="mso-spacerun: yes;"> </span>yang dihadapinya.</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l75 level1 lfo69; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberikan kesempatan bagi klien dan pasangannya
untuk mengekspresikan perasaan dan keinginan secara wajar.</div>
<div class="MsoNormal" style="line-height: 150%; text-indent: -21.85pt;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 0cm; mso-list: l29 level1 lfo15; tab-stops: list 0cm; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span>Resiko tinggi kerusakan integritas kulit berhubungan
dengan efek radiasi dan kemotherapi, deficit imunologik, penurunan intake
nutrisi dan anemia.</div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l45 level1 lfo81; tab-stops: list 21.85pt left 28.05pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien dapat mengidentifikasi intervensi yang
berhubungan dengan kondisi spesifik</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l45 level1 lfo81; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berpartisipasi dalam pencegahan komplikasi dan
percepatan penyembuhan.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: 24.1pt; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">INTERVENSI</b></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">RASIONAL</b></div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 208.05pt;" valign="top" width="277">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l21 level1 lfo70; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kaji integritas kulit untuk melihat adanya efek
samping therapi kanker, amati penyembuhan luka.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l21 level1 lfo70; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan klien untuk tidak menggaruk bagian yang
gatal.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l21 level1 lfo70; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ubah posisi klien secara teratur.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 4.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l21 level1 lfo70; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan advise pada klien untuk menghindari pemakaian
cream kulit, minyak, bedak tanpa rekomendasi dokter.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 232.2pt;" valign="top" width="310">
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l51 level1 lfo71; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memberikan informasi untuk perencanaan asuhan dan
mengembangkan identifikasi awal terhadap perubahan integritas kulit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l51 level1 lfo71; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menghindari perlukaan yang dapat menimbulkan infeksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l51 level1 lfo71; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menghindari penekanan yang terus menerus pada suatu
daerah tertentu.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l51 level1 lfo71; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mencegah trauma berlanjut pada kulit dan produk yang
kontra indikatif</div>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<div class="WordSection3">
<div class="MsoTitle" style="line-height: 150%;">
DAFTAR PUSTAKA</div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 6.0pt; text-indent: -2.0cm;">
Carpenito,
Lynda Juall. (1999). <b style="mso-bidi-font-weight: normal;"><i>Rencana Asuhan
& Dokumentasi Keperawatan</i></b>. Edisi 2. <span style="mso-bidi-font-weight: bold;">(terjemahan). Penerbit buku Kedokteran EGC. </span>Jakarata.</div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 6.0pt; text-indent: -2.0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-indent: -58.5pt;">
Carpenito, Lynda Juall. (2000.). <b><i>Buku Saku Diagnosa Keperawatan.</i>
</b>Edisi 8. <span style="mso-bidi-font-weight: bold;">(terjemahan). Penerbit
buku Kedokteran</span> EGC. Jakarta.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-indent: -2.0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; text-indent: -49.65pt;">
<span style="mso-bidi-font-weight: bold;">Doenges, Marilynn E. (</span>1999<span style="mso-bidi-font-weight: bold;">). </span><b style="mso-bidi-font-weight: normal;"><i>Rencana Asuhan Keperawatan</i></b><span style="mso-bidi-font-weight: bold;">. Edisi 3. (terjemahan). Penerbit buku Kedokteran EGC. Jakarta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; text-indent: -49.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: skip; text-indent: -54.0pt;">
Engram, Barbara. (1998). <b><i>Rencana Asuhan Keperawatan
Medikal Bedah</i></b>. Volume 2, (terjemahan). <span style="line-height: 150%; mso-bidi-font-size: 10.0pt;">Penerbit Buku Kedokteran</span> EGC. Jakarta.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-indent: -2.0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 2.0cm; text-indent: -2.0cm;">
Junadi, Purnawan. (1982). <b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">Kapita Selekta Kedokteran</i></b>, Jakarta:
Media Aesculapius Fakultas Kedokteran Universitas Indonesia.</div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 6.0pt; text-indent: -2.0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; tab-stops: 54.0pt; text-indent: -54.0pt;">
<span style="mso-bidi-font-weight: bold;">Long, Barbara C.
(1996). </span><b style="mso-bidi-font-weight: normal;"><i>Perawatan Medikal
Bedah</i></b><i><span style="mso-bidi-font-weight: bold;">.</span></i><span style="mso-bidi-font-weight: bold;"> Volume I. (terjemahan). Yayasan Ikatan
Alumni Pendidikan Keperawatan Pajajaran. Bandung.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-indent: -58.5pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 6.0pt; text-indent: -2.0cm;">
Mansjoer,
Arif., et all. (1999). <b style="mso-bidi-font-weight: normal;"><i>Kapita Selekta
Kedokteran</i></b>. Fakultas Kedokteran UI : Media Aescullapius.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 12.0pt; text-indent: -58.5pt;">
<u><span style="mso-spacerun: yes;"> </span>(</u>1994). <b>Pedoman
Diagnosis Dan Terapi Ilmu Bedah.</b> Fakultas Kedokteran Unair & RSUD dr
Soetomo Surabaya </div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US; text-transform: uppercase;"><br clear="all" style="page-break-before: always;" />
</span></b>
<div class="MsoTitle" style="line-height: 150%;">
ASUHAN KEPERAWATAN<span style="mso-spacerun: yes;"> </span>PADA KLIEN DENGAN </div>
<div class="MsoTitle" style="line-height: 150%;">
GANGGUAN SISTEM PERKEMIHAN<span style="mso-spacerun: yes;"> </span>(KARSINOMA BULI-BULI)</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<b style="mso-bidi-font-weight: normal;">DI<span style="mso-spacerun: yes;">
</span>RUANG<span style="mso-spacerun: yes;"> </span>BEDAH D<span style="mso-spacerun: yes;"> </span>RUMAH<span style="mso-spacerun: yes;">
</span>SAKIT<span style="mso-spacerun: yes;"> </span>Dr.<span style="mso-spacerun: yes;"> </span>SOETOMO<span style="mso-spacerun: yes;">
</span>SURABAYA</b></div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<div class="MsoTitle" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoTitle" style="line-height: 150%; text-align: justify;">
A. PENGKAJIAN DATA</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; mso-list: l44 level3 lfo36; tab-stops: list 117.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>IDENTITAS</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; tab-stops: 93.5pt;">
Nama<span style="mso-spacerun: yes;"> </span>: Tn.K.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Umur<span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;">
</span>: 51 tahun.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Jenis Kelamin :
Laki-laki.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Suku/Bangsa<span style="mso-spacerun: yes;"> </span>: Jawa/Indonesia.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Agama<span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;">
</span>: Islam.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Pekerjaan<span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>:
wiraswasta.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Pendidikan<span style="mso-spacerun: yes;"> </span>: SLTA</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Alamat<span style="mso-spacerun: yes;"> </span>: Kali Tengah Lamongan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 102.85pt; text-indent: -102.85pt;">
2.<span style="mso-spacerun: yes;"> </span>Alasan Dirawat: </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 102.85pt; text-indent: -84.15pt;">
Kencing keluar darah</div>
<div class="MsoNormal" style="line-height: 150%;">
3.<span style="mso-spacerun: yes;">
</span>Keluhan Utama </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Kencing keluar
darah</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
P, Kencing
keluar darah</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Q, kencing hanya
bisa menetes, tidak dapat tuntas, terasa ada sisa,<span style="mso-spacerun: yes;"> </span>pancaran tidak jauh dan terasa nyeri. Saat
dikaji klien cemas menunggu jadwal operasi </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
R, Terasa ada benjolan
pada perut bagian bawah dan masih kecil. Upaya yang telah dilakukan berobat ke
RS Muhammadiyah kemudian dirujuk ke RSUD Dr. Soetomo. Dan mendapatka pengobtan
da n perawatan dipasang slang kencing dan diberikan irigasi cairan untuk
mengurangi persaraham. Terapi/Operasi yang pernah dilakukan: tidak ada.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 28.05pt; text-indent: -9.35pt;">
T, Sejak 10 hari yang lalu</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 102.85pt; text-indent: -84.15pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l44 level2 lfo36; tab-stops: list 36.0pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";">
</span></span>RIWAYAT KEPERAWATAN (NURSING HISTORY)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l25 level1 lfo72; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat Penyakit Sebelumnya:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Klien ada
riwayat kencing warna meraj 6 bulan yang lalu dan <span style="font-family: Symbol; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">±</span></span> 10 hari yang lalu selama
1 minggu klien merasa ada benjolan diperut bagian bawahnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l25 level1 lfo72; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat Penyakit Sekarang:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
BAK tidak
lancar, terasa nyeri dan panas, sifatnya terus menerus sejak 10 hari yang
lalu.<span style="mso-spacerun: yes;"> </span>Klien juga merasa kesulitan dalam
BAB, konsistensi keras dan lama baru keluar. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l25 level1 lfo72; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span>Riwayat Kesehatan Keluarga:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Dalam
keluarganya tidak ada yang menderita penyakit seperti yang diderita oleh klien
sekarang ini.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l25 level1 lfo72; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span>Keadaan Kesehatan Lingkungan:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Klien tinggal di
perkampungan yang kondisinya sangat sederhana.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l25 level1 lfo72; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span>Alat Bantu Yang Dipakai: tidak ada.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; mso-list: l44 level2 lfo36; tab-stops: list 36.0pt; text-indent: -18.7pt;">
<span style="mso-list: Ignore;">III.<span style="font: 7.0pt "Times New Roman";"> </span></span>OBSERVASI
DAN PEMERIKSAAN FISIK</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt;">
Keadaan Umum:
cukkup</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Klien tampak
pucat, melakukan aktivitas seperlunya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.7pt;">
Tanda-tanda
Vital:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt;">
Suhu 36,5<sup>o</sup>C/axilla,
nadi kuat dan teratur, 84x/menit, tensi diukur dengan klien berbaring pada
lengan kiri, hasilnya= 180/100 mmHg, pernafasan normal, 20x/menit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 9.7pt;">
<b>SISTEM TUBUH
(BODY SYSTEMS):</b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>PERNAFASAN (B1: BREATHING)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Pernafasan
vesikuler,retraksi intercostals dan klavikula tidak ditemukan ,<span style="mso-spacerun: yes;"> </span>Rh -/-. Wh -/-/, batuk (-), pilek (-)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>CARDIOVASCULAR (B2: BLEEDING)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Nyeri dada (-),
Jantung S1S2 tunggal normal HT 180/100 mmHg, Odema ekstremitas atas dan bawah
(-)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>PERSYARAFAN (B3: BRAIN)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Kesadaran:
compos mentis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
GCS<span style="mso-spacerun: yes;"> </span>: E= 4<span style="mso-spacerun: yes;"> </span>V=5<span style="mso-spacerun: yes;">
</span>M= 6 Total nilai: 15</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Kepala dan
wajah: tidak ada kelainan, kesan= pucat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Mata sklera:
tidak icterus, conjunctiva: pucat, pupil : isokor.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<span style="mso-spacerun: yes;"> </span>Leher: tekanan vena jugularis normal.<span style="mso-spacerun: yes;"> </span>Klien tidak mengalami cegukan.</div>
<h3 style="line-height: 150%; margin-left: 46.75pt; tab-stops: list 32.2pt 43.65pt;">
<span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span>Persepsi Sensori</h3>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<span style="mso-tab-count: 1;"> </span>Pendengaran: tidak ada kelainan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-indent: -37.4pt;">
<span style="mso-tab-count: 1;"> </span>Penciuman<span style="mso-spacerun: yes;"> </span>: tidak ada kelainan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-indent: -37.4pt;">
<span style="mso-tab-count: 1;"> </span>Pengecapan : tidak ada
kelainan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-indent: -46.75pt;">
<span style="mso-tab-count: 1;"> </span>Penglihatan : tidak
ada kelainan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Perabaan<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>:
tidak ada kelainan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>PERKEMIHAN- ELIMINASI URI (B4: BLADDER)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 130.9pt; text-indent: -84.15pt;">
Produksi urine: dalam 24 jam <u>+</u> 700 ml, keluar melalui dower
kateter yang terpasang sejak tanggal 9 Perburari 2002, terpasang irigrasi Nacl
0,9 %</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -10.25pt;">
Warna<span style="mso-spacerun: yes;"> </span>: merah.<span style="mso-spacerun: yes;"> </span>Bau: agak amis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -10.25pt;">
Lainnya<span style="mso-spacerun: yes;"> </span>: teraba massa
supra sympisis, diameter 10 x 10 cm, keras, fixed.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>PENCERNAAN – ELIMINASI ALVI (B5: BOWEL)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Mulut dan
tenggorok: kering, agak merah (iritasi).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Abdomen<span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>: flat, supel, distensi (-)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Rectum<span style="mso-tab-count: 2;"> </span><span style="mso-spacerun: yes;"> </span>: tidak ada kelainan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
BAB<span style="mso-tab-count: 2;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>: belum mulai masuk rumah sakit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Konsistensi:
keras.<span style="mso-spacerun: yes;"> </span>Ada konstipasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;">
</span>Berat Badan (BB)<span style="mso-spacerun: yes;"> </span>: tanggal 21
April 2001 = 70 kg.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<span style="mso-tab-count: 4;"> </span><span style="mso-spacerun: yes;"> </span>Tanggal 9 Mei 2001 = 57 kg.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-indent: -56.1pt;">
<span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>Diet<span style="mso-tab-count: 2;"> </span><span style="mso-spacerun: yes;"> </span>: TKTPRG.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-indent: -56.1pt;">
<span style="mso-tab-count: 1;"> </span>Pelvis :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
- Flank mass
_/-, flank pain -/-</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
RT :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
- BCR (-), TSA
(+), Prostat membesar, Nodul (-)<span style="mso-tab-count: 2;"> </span><span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>TULANG – OTOT – INTEGUMEN (B6: BONE)</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 215.05pt; text-indent: -177.65pt;">
<i>Kemampuan pergerakan sendi</i>:<span style="mso-spacerun: yes;"> </span>bebas.<span style="mso-spacerun: yes;">
</span>Tidak ada parese, paralise maupun hemiparese.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -.9pt;">
<i>Extremitas:</i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -.9pt;">
<span style="mso-spacerun: yes;"> </span>- Atas<span style="mso-tab-count: 1;"> </span>: tidak ada kelainan.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -.9pt;">
<span style="mso-spacerun: yes;"> </span>- Bawah<span style="mso-tab-count: 1;"> </span>: tidak terdapat edema apda tungkai kiri.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -.9pt;">
<i>Tulang Belakang</i>: tidak ada kelainan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -.9pt;">
<i>Kulit:</i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -.9pt;">
<span style="mso-spacerun: yes;"> </span>-Warna kulit: pucat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -.9pt;">
<span style="mso-spacerun: yes;"> </span>- Akral : hangat kering.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt; text-indent: -.9pt;">
<span style="mso-spacerun: yes;"> </span>- Turgor: cukup.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>SISTEM ENDOKRIN</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Terapi hormon:
tidak ada.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 43.65pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>SISTEM HEMATOPOIETIK:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt;">
Diagnosis
penyakit hematopoietik yang lalu: </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt;">
<span style="mso-spacerun: yes;"> </span>- Anemia.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 84.15pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Transfusi darah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 84.15pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Tipe darah: PRC 2 kolf</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">i.<span style="font: 7.0pt "Times New Roman";">
</span></span>REPRODUKSI</div>
<h5 style="line-height: 150%;">
<span style="mso-bidi-font-style: normal; mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";">
</span></span></span>Laki-laki</h5>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
Penis<span style="mso-spacerun: yes;"> </span>: klien telah disirkumsisi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
Scrotum:
tidak<span style="mso-spacerun: yes;"> </span>terdapat edema minimal.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">j.<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>PSIKOSOSIAL</div>
<div class="MsoNormal" style="line-height: 150%;">
<u>Konsep diri:</u></div>
<div class="MsoNormal" style="line-height: 150%;">
Identitas</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Status klien
dalam keluarga: suami. Dari 1 isteri dan anak satu</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Kepuasan klien
terhadap status dan posisinya dalam keluarga: puas.</div>
<div class="MsoNormal" style="line-height: 150%;">
Peran</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Tanggapan klien
terhadap perannya: senang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Kemampuan/kesanggupan
klien melaksanakan perannya: sanggup.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Kepuasan klien
melaksanakan perannya: puas.</div>
<div class="MsoNormal" style="line-height: 150%;">
Ideal diri/Harapan</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Harapan klien
terhadap:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Tugas/pekerjaan: dapat melakukan pekerjaan seperti
biasa (sebagai wiawasta).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Tempat/lingkungan kerja: dapat kembali bekerja seperti
semula.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Harapan klien
terhadap penyakit yang sedang dideritanya:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
Klien berharap
agar segera dilakukan operasi biar cepat sembuh.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt;">
<span style="mso-spacerun: yes;"> </span>Lainnya: klien menganggap apabila tumornya
diangkat dengan operasi maka ia akan sembuh total.</div>
<div class="MsoNormal" style="line-height: 150%;">
Harga diri</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; text-indent: -20.1pt;">
<span style="mso-tab-count: 1;"> </span>Tanggapan klien terhadap
harga dirinya: sedang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-indent: -20.1pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-indent: -20.1pt;">
<span style="mso-tab-count: 1;"> </span><u>Sosial/Interaksi</u></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-indent: -20.1pt;">
<span style="mso-tab-count: 1;"> </span>Hubungan dengan klien: tidak
kenal.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-indent: -20.1pt;">
<span style="mso-tab-count: 1;"> </span>Dukungan keluarga<span style="mso-spacerun: yes;"> </span>: aktif.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-indent: -20.1pt;">
<span style="mso-tab-count: 1;"> </span>Dukungan kelompok/teman/masyarakat:
kurang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-indent: -20.1pt;">
<span style="mso-tab-count: 1;"> </span>Reaksi saat interaksi<span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;">
</span>: kontak mata.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; text-indent: -20.1pt;">
<span style="mso-tab-count: 1;"> </span>Konflik yang terjadi
terhadap: peran.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l48 level2 lfo33; tab-stops: list 43.65pt; text-indent: -21.8pt;">
<span style="mso-list: Ignore;">k.</span> SPIRITUAL</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt;">
Konsep tentang
penguasa kehidupan: Allah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt;">
Ritual agama
yang bermakna/berarti/diharapkan saat ini: sholat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt;">
Sarana/peralatan/orang
yang diperlukan untuk melaksanakan ritual agama yang diharapkan saat ini: lewat
ibadah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt;">
Upaya kesehatan
yang bertentangan dengan keyakinan agama: tidak ada.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt;">
Keyakinan/kepercayaan
bahwa penyakit dapat disembuhkan: klien<span style="mso-spacerun: yes;">
</span>mempercayainya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 57.0pt;">
Persepsi
terhadap penyebab penyakit: sebagai cobaan/peringatan.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
IV Pemeriksaan Penunjang</div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-tab-count: 1;"> </span><i>Pemeriksaan
laboratorium tanggal 25-1-2002:</i></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>Leukosit<span style="mso-tab-count: 1;"> </span>: 9,9 x 1000/UL</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Erythrocyt: 3,33 x 1 juta/UL</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Hb<span style="mso-tab-count: 2;"> </span>:
10,4 g/dl.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>PCV<span style="mso-tab-count: 1;"> </span>:
30,1%</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>MCV<span style="mso-tab-count: 1;"> </span>: 40,4
FL</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>MCH<span style="mso-tab-count: 1;"> </span>: 31,2</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Trombosit : 310 x 1000/UL</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Albumin<span style="mso-spacerun: yes;"> </span>: 3,5
g/dl.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Diff count : 2/-/3/31/14/-</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>LED<span style="mso-tab-count: 1;"> </span>: 98
mm/jam.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<i>Pemeriksaan
mikrobiologi</i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<i>Tanggal
11-2-2002 hasi; tanggal 13-02 -2002</i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<span style="mso-bidi-font-style: italic;">Sediian mengnadung sedikit sel epithel
sqaumosa, sel-sel radang tidak ditemukan keganansan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
<i>Tanggal
15-2-2002</i></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
Fungsi dan anak
kedua ginjal normal, kedua kureter normal, trabekulasi dasr buli-bili kiri,
hiperprostat, suspect sistitis, spondilitis kulit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
IVP :
Iregulasitas dinding buli-buli oleh karena obstruksi kronis, keadaan ginjal dan
ureter normal</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 46.75pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -9.35pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>USG urologis tanggal 26-01-2002</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
<span style="mso-spacerun: yes;"> </span>Ditemukan Bood clot di buli-buli</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
- Endoskopi
(tanggal 15 -02-20020</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; text-indent: -37.4pt;">
<span style="mso-tab-count: 1;"> </span>Mukosa buli-buli :</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
- trabekulum
berat, divertikel (-) banyak sel, trigonum didapatkan tumor dinding anterior
buli-buli, ureter normal, spinkter internus normal, ureter prostatik kisingg 1
cm, spinkter eksternus normal, ureter dan panjang urieter normal.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; text-indent: -37.4pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
Terapi:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt;">
Infus RL : D5= 2
: 3 20 tetes/menit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
Irigasi PZ </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
Klanex 3x1 amp</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
Mobilisasi</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt;">
Kultur urine,
IVP, Endosopi</div>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" />
</span>
<div class="WordSection4">
<div class="MsoTitle" style="line-height: 150%;">
ANALISA DATA</div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; width: 1021px;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.25pt;" valign="top" width="94">
<div class="MsoTitle" style="line-height: 150%;">
TANGGAL</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="150">
<div class="MsoTitle" style="line-height: 150%;">
KELOMPOK DATA</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 93.5pt;" valign="top" width="125">
<div class="MsoTitle" style="line-height: 150%;">
KEMUNGKINAN</div>
<div class="MsoTitle" style="line-height: 150%;">
PENYEBAB</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 85.65pt;" valign="top" width="114">
<div class="MsoTitle" style="line-height: 150%;">
MASALAH</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 102.15pt;" valign="top" width="136">
<div class="MsoTitle" style="line-height: 150%;">
DIAGNOSA</div>
<div class="MsoTitle" style="line-height: 150%;">
KEPERAWATAN</div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 70.25pt;" valign="top" width="94">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 11.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">18 -02-2002</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 112.8pt;" valign="top" width="150">
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.9pt; text-indent: -13.9pt;">
S: Klien menanya-<span style="mso-spacerun: yes;"> </span>kan kapan
opera-sinya dilaksana-kan, karena biaya selama menunggu jadwal operasi
se-makin menipis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
O: -Operasi belum di<span style="mso-spacerun: yes;">
</span>lakukan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.9pt; text-indent: -13.9pt;">
<span style="mso-spacerun: yes;"> </span>-Klien gelisah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
<span style="mso-spacerun: yes;"> </span>-Klien tampak
kelelahan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
<span style="mso-spacerun: yes;"> </span>-Mata klien
tam-pak merah kare-na kurang tidur.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.9pt; text-indent: -13.9pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.9pt; text-indent: -13.9pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.9pt; text-indent: -13.9pt;">
S: Klien berpikir bahwa dengan o-perasi maka dia pasti sembuh to-tal.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
O: -Pendidikan klien SD tidak sam-pai tamat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
<span style="mso-spacerun: yes;"> </span>-Klien selalu
ber-tanya tentang penyakit & jad-wal operasinya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
<span style="mso-spacerun: yes;"> </span>-Klien merasa
ti-dak diperhati-kan/tidak dioba-ti.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.9pt; text-indent: -13.9pt;">
S: Klien mengatakan kencingnya masih berwarna merah & menetes.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
O:-Warna kencing merah & berbau amis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 23.25pt; text-indent: -23.25pt;">
<span style="mso-spacerun: yes;"> </span>-Produksi urine
dalam 24 jam: 600-700 ml.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 93.5pt;" valign="top" width="125">
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">Situasi
krisis (kanker) & sosio ekonomi.</span></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">.</span></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">Kurangnya
in-</span></div>
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">formasi
& keter-batasan kognitif.</span></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">Blood
Clothing akibat kanker.</span></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 85.65pt;" valign="top" width="114">
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">Cemas</span></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">.</span></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">Kurang
penge-tahuan tentang penyakit, prog-nosis & pengo-batan.</span></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<br /></div>
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">Gangguan
eli-minasi urine (retensi)</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 102.15pt;" valign="top" width="136">
<div class="MsoNormal" style="line-height: 150%;">
Cemas berhubung-an dengan situasi
krisis (kanker) dan sosio ekonomi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
Kurang pengeta-huan tentang
pe-nyakit, prognosis & pengobatan ber-hubungan dengan kurangnya
infor-masi & keterbatas-an kognitif.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
Gangguan elimi-nasi urine
(retensi) berhubungan de-ngan blood clo-thing akibat ada-nya kanker.</div>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: right;" />
</span>
<div class="WordSection5">
<div class="MsoTitle" style="line-height: 150%;">
RENCANA TINDAKAN PERAWATAN</div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; width: 1021px;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.25pt;" valign="top" width="34">
<div class="MsoTitle" style="line-height: 150%;">
NO</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.25pt;" valign="top" width="48">
<div class="MsoTitle" style="line-height: 150%;">
TGL</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.85pt;" valign="top" width="200">
<div class="MsoTitle" style="line-height: 150%;">
DIAGNOSA KEPERAWATAN</div>
<div class="MsoTitle" style="line-height: 150%;">
& HASIL YANG DIHARAPKAN</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.75pt;" valign="top" width="174">
<div class="MsoTitle" style="line-height: 150%;">
RENCANA TINDAKAN</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 122.25pt;" valign="top" width="163">
<div class="MsoTitle" style="line-height: 150%;">
RASIONAL</div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 25.25pt;" valign="top" width="34">
<div class="MsoNormal" style="line-height: 150%;">
1</div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
2.</div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
3.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
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<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.25pt;" valign="top" width="48">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">18-02 2002</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">18-02- 2002</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">18-02- 2002</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.85pt;" valign="top" width="200">
<div class="MsoNormal" style="line-height: 150%;">
Cemas berhubungan dengan situasi
krisis (kanker) & sosio ekonomi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -18.7pt;">
a. Klien dapat mengurangi ra-sa cemasnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -18.7pt;">
b. Klien rileks & dapat meli-hat dirinya secara objektif.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.85pt; mso-list: l75 level1 lfo69; tab-stops: list 21.85pt; text-indent: -21.85pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menunjukkan koping yang efektif.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.45pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.45pt;">
Kriteria
Hasil:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 12.55pt; mso-list: l6 level1 lfo40; tab-stops: list 12.55pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien melaporkan perasa-an cemasnya berkurang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 12.55pt; mso-list: l6 level1 lfo40; tab-stops: list 12.55pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien menyatakan pema-hamannya tentang penya-kit.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.45pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.45pt;">
Rencana
Tindakan:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 12.55pt; mso-list: l65 level1 lfo41; tab-stops: list 12.55pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Cemas hilang dalam 24 jam.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 12.55pt; mso-list: l65 level1 lfo41; tab-stops: list 12.55pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien memiliki & mengi-kuti program JPS.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 12.55pt; mso-list: l65 level1 lfo41; tab-stops: list 12.55pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mau menunggu jad-wal operasi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
Kurang pengetahuan tentang
penyakit, prognosis & pe-ngobatan berhubungan de-ngan kurangnya informasi
keterbatasan kognitif.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
Tujuan:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
-Klien dapat mengatakan se-cara akurat tentang diagno-sa &
pengobatan pada ting-katan siap.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
-Mempunyai inisiatif dalam perubahan gaya hidup & berpartisipasi
dalam pengo-batan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
-Mengikuti prosedur pengo-batan & bekerjasama deng-an
perawat/dokter.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
Kriteria Hasil:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
-Klien siap untuk dioperasi, baik secara fisik maupun mental.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
-Klien mau berpartisipasi dalam perubahan gaya hi-dup.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.4pt;">
Gangguan
eliminasi urine (retensi)<span style="mso-spacerun: yes;"> </span>berhubungan
deng-an blood clothing akibat ada-nya kanker.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.4pt;">
Tujuan:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.4pt;">
- Retensi
urine tidak terjadi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.4pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -5.4pt;">
Kriteria
Hasil:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Klien berkemih
volunteer.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Residu urine
kurang dari 50 cc.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Urine tidak
lagi berwarna merah & menetes.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -3.95pt;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 130.75pt;" valign="top" width="174">
<div class="MsoNormal" style="line-height: 150%; margin-left: 10.75pt; mso-list: l35 level1 lfo43; tab-stops: list 12.6pt; text-indent: -16.15pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tentukan penga-laman klien se-belumnya terha-dap
penyakit yang dideritanya.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -9.4pt;">
b.Berikan informasi<span style="mso-spacerun: yes;"> </span>tentang
prognosis secara akurat.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -9.4pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -9.4pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; text-indent: -9.4pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l6 level1 lfo40; tab-stops: list 12.55pt; text-indent: -8.75pt;">
<span style="mso-list: Ignore;">c.</span>Jelaskan pengobatan, tujuan dan
efek sam-ping. Bantu klien mem-persiapkan diri da-lam pengobatan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l6 level1 lfo40; tab-stops: 10.75pt list 12.55pt; text-indent: -8.75pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Catat koping yang ti-dak efektif seperti ku-rang
interaksi sosial, ketidak berdayaan dll.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt; tab-stops: 10.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt; tab-stops: 10.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt; tab-stops: 10.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt; tab-stops: 10.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt; tab-stops: 10.75pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l6 level1 lfo40; tab-stops: list 12.55pt; text-indent: -8.75pt;">
<span style="mso-list: Ignore;">e.</span>Anjurkan untuk mengembangkan
interaksi dengan support system.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l6 level1 lfo40; tab-stops: list 12.55pt; text-indent: -8.75pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span>Berikan
lingkungan yang tenang dan nya-man.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l6 level1 lfo40; tab-stops: list 12.55pt; text-indent: -8.75pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Pertahankan kontak dengan klien, bicara dan sentuhlah
dengan wajar.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l6 level1 lfo40; tab-stops: 3.95pt list 12.55pt; text-indent: -8.75pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Jelaskan tentang kebijakan pemerin-tah & RS
tentang penanga-nan bagi klien tidak mampu serta program JPS.</div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 3.95pt 13.3pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l72 level1 lfo46; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Review pengertian klien & keluarga ten-tang
diagnosa pengo-batan & akibatnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l72 level1 lfo46; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tentukan persepsi klien tentang kanker &
pengobatannya.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l72 level1 lfo46; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Berikan bimbingan kepada klien sebelum mengikuti
prosedur pengobatan, terapi yang lama, komplika-si.<span style="mso-spacerun: yes;"> </span>Jujurlan kepada klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l72 level1 lfo46; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan klien untuk memberikan umpan balik verbal
& meng-koreksi mis komuni-kasi tentang penyakit-nya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l72 level1 lfo46; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan klien untuk memelihara kebersih-an kulit
& rambut.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l72 level1 lfo46; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Jelaskan kepada klien /keluarga tentang pentingnya
status nut-risi yang optimal.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l55 level1 lfo48; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Anjurkan klien untuk banyak minum air pu-tih.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l55 level1 lfo48; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kembangkan kemba-li program latihan Buli-buli atau
pengkondisian kem-bali.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l55 level1 lfo48; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ajarkan klien mere-gangkan abdomen & melakukan
manuver<span style="mso-spacerun: yes;"> </span>varsava jika diindika-sikan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l55 level1 lfo48; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ajarkan klien manu-ver crede jika diindi-kasikan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l55 level1 lfo48; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ajarkan klien manu-ver regangan anal jika
diindikasikan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l55 level1 lfo48; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Ukur residu pasca berkemih setelah usa- ha
mengosongkan Buli-buli jika volume urine lebih dari 100 cc.<span style="mso-spacerun: yes;"> </span>Jadwal-kan program kateteri-sasi
intermitten.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l55 level1 lfo48; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";">
</span></span>Observasi pemeberian cairan irigasi pada kandung
kencing lewat kateter try way</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.05pt; mso-list: l55 level1 lfo48; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";">
</span></span>Observasi intake dan output cairan</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 122.25pt;" valign="top" width="163">
<div align="left" class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; mso-list: l9 level1 lfo42; tab-stops: list 16.65pt; text-align: left; text-indent: -9.35pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span>Data-data
mengenai pengalaman klien se-belumnya akan mem berikan dasar untuk penyuluhan
dan menghindari adanya duplikasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -1.4pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; text-indent: -9.35pt;">
b.Pemberian informasi dapat membantu klien dalam mema-hami proses
penya-kitnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; text-indent: -9.35pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -18.8pt;">
c.<span style="mso-spacerun: yes;"> </span>Membantu klien da-lam
memahami ke-butuhan untuk pe-ngobatan dan efek sampingnya.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; mso-list: l65 level1 lfo41; tab-stops: list 12.55pt; text-indent: -9.35pt;">
<span style="mso-list: Ignore;">d.</span>Mengetahui dan menggali pola
ko-ping klien serta me-ngatasinya/membe-rikan solusi dalam upaya meningkatkan
kekuatan dalam me-ngatasi kecemasan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -1.4pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; mso-list: l65 level1 lfo41; tab-stops: list 12.55pt; text-indent: -9.35pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span>Agar
klien mempe-roleh dukungan dari orang yang terdekat/keluarga.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; mso-list: l65 level1 lfo41; tab-stops: list 12.55pt; text-indent: -9.35pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span>Memberikan
ke-sempatan pada klien merenung/istirahat.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; text-indent: -9.35pt;">
g.<span style="mso-spacerun: yes;"> </span>Klien mendapatkan
kepercayaan diri dan keyakinan bahwa dia benar-benar ditolong.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; text-indent: -9.35pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 7.95pt; text-indent: -9.35pt;">
h. Memberikan infor-masi mengenai alter-natif pembiayaan.<br style="mso-special-character: line-break;" />
<br style="mso-special-character: line-break;" />
</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; mso-list: l61 level1 lfo47; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Menghindari dupli-kasi & pengulangan terhadap pengetahu-an
klien.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; mso-list: l61 level1 lfo47; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Memungkinkan di lakukan pembinaan terhadap kesalahan
persepsi & konsepsi serta pengertian.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; mso-list: l61 level1 lfo47; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Membantu klien dalam memahami proses penyakit &
pengobatannya.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; mso-list: l61 level1 lfo47; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengetahui sampai sejauhmana pema-haman klien &
ke-luarga.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; mso-list: l61 level1 lfo47; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";">
</span></span>Meningkatkan in-tegritas kulit & ke-pala.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; mso-list: l61 level1 lfo47; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sebagai upaya per-cepatan penyembuh an &
pencegahan infeksi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; text-indent: -13.2pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; mso-list: l2 level1 lfo49; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Agar tidak sempat terbentuk bekuan darah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.2pt; mso-list: l2 level1 lfo49; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Agar kandung ke-mih dapat berfungsi kembali secara
nor-mal.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
c, d, dan e. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
Untuk melatih
mengo-songkan kandung ke-mih secara bertahap/se-suai teknik-teknik ter-tentu.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.8pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.85pt; text-indent: -8.65pt;">
f. Untuk mengetahui efektifitas latihan Buli-buli, bila gagal dapat
segera diambil tindakan de-ngan kateterisasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.85pt; text-indent: -8.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.85pt; text-indent: -8.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.85pt; text-indent: -8.65pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.85pt; text-indent: -8.65pt;">
g. Observasi intake dan output untuk mengkaji konsistensi, warna dan
obstruksi dalam kandung kencing.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.85pt; text-indent: -8.65pt;">
h. Intake da output untuk menentukan balance cairan.</div>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: right;" />
</span>
<div class="WordSection6">
<div class="MsoTitle" style="line-height: 150%;">
TINDAKAN KEPERAWATAN</div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; width: 1021px;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 52.15pt;" valign="top" width="70">
<div class="MsoTitle" style="line-height: 150%;">
TGL</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 46.75pt;" valign="top" width="62">
<div class="MsoTitle" style="line-height: 150%;">
JAM</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 365.45pt;" valign="top" width="487">
<div class="MsoTitle" style="line-height: 150%;">
TINDAKAN KEPERAWATAN</div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 52.15pt;" valign="top" width="70">
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">18-02-
2002</span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 46.75pt;" valign="top" width="62">
<div class="MsoNormal" style="line-height: 150%;">
11<sup><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">25</span></sup><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;"> </span>wib</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<i>s/d</i></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
13<sup><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">00</span></sup> wib</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
08<sup><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">45</span></sup></div>
<div class="MsoNormal" style="line-height: 150%;">
wib</div>
<div class="MsoNormal" style="line-height: 150%;">
<i>s/d</i></div>
<div class="MsoNormal" style="line-height: 150%;">
09<sup><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">25 </span></sup></div>
<div class="MsoNormal" style="line-height: 150%;">
wib.</div>
<div class="MsoNormal" style="line-height: 150%;">
10<sup><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">15</span></sup> wib</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
11<sup><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">20</span></sup></div>
<div class="MsoNormal" style="line-height: 150%;">
wib</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
12<sup><span style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">45</span></sup></div>
<div class="MsoNormal" style="line-height: 150%;">
wib</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 365.45pt;" valign="top" width="487">
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Menggali
pengetahuan klien tentang penyakitnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Menjelaskan
tentang penyakitnya, pengobatan & prognosisnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Menganjurkan
istri klien untuk selalu mendampingi & memberikan support pada suaminya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Memberi
semangat & dukungan pada klien<span style="mso-spacerun: yes;">
</span>agar sabar dalam menunggu jadwal operasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengukurs tensi 140/80 mmHg, nadi 88 kali/menit </div>
<div class="MsoNormal" style="line-height: 150%;">
- Mngobservasi pemberian cairan
irigrasi dengan PZ sampai warna kencing warna merah bening tidak ada kloting</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Memberikan
motivasi agar klien sabar menunggu saat pelaksanaan ope-rasi.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Menjelaskan tindakan insisi skrotum & sitoskopy.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.7pt;">
- memotivasi
klien untuk minum banyak > 2 liter/hari</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Menganjurkan klien untuk istirahat & banyak minum
air putih.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -4.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span><span style="mso-spacerun: yes;"> </span>Mengajarkan
klien meregangkan abdomen & melakukan manuver valsa-va:</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.95pt; mso-list: l46 level1 lfo50; tab-stops: list 21.95pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span>Sandarkan kepala kedepan pada kedua paha.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.95pt; mso-list: l46 level1 lfo50; tab-stops: list 21.95pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span>Kontraksikan otot abdomen jika mungkin &
regangan/mengejan, tahan nafas sambil meregangkan (manuver varsava).</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.95pt; mso-list: l46 level1 lfo50; tab-stops: list 21.95pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span>Tahan regangan/nafas sampai aliran urine berhenti,
tunggu 1 menit & regangkan kembali sepanjang mungking.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.95pt; mso-list: l46 level1 lfo50; tab-stops: list 21.95pt; text-indent: -18.0pt;">
<span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span>Lanjutkan sampai tidak ada lagi urine yang keluar.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengobeseravasi pemeberian cairan irgasi </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 3.95pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.65pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Mengobservasi intake cairan dan output dan mencatat
pada lebaran obsecrvasi (produksi kencing 1750 cc) warna kemerahan.</div>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: right;" />
</span>
<div class="WordSection7">
<div class="MsoTitle" style="line-height: 150%;">
EVALUASI</div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; width: 1021px;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.1pt;" valign="top" width="32">
<div class="MsoTitle" style="line-height: 150%;">
NO.</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 46.75pt;" valign="top" width="62">
<div class="MsoTitle" style="line-height: 150%;">
TANGGAL</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 102.85pt;" valign="top" width="137">
<div class="MsoTitle" style="line-height: 150%;">
DIAGNOSA </div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 290.65pt;" valign="top" width="388">
<div class="MsoTitle" style="line-height: 150%;">
EVALUASI </div>
</td>
</tr>
<tr style="mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.1pt;" valign="top" width="32">
<div class="MsoNormal" style="line-height: 150%;">
1.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
2.</div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
3.</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 46.75pt;" valign="top" width="62">
<div class="MsoHeader" style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif";">18-02-
2002</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 102.85pt;" valign="top" width="137">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
1</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
1</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
1</div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
3</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 290.65pt;" valign="top" width="388">
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.9pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Pengetahuan klien akan penyakit & prosedur
pe-ngobatan serta prognosenya masih perlu dilurus-kan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien masih bertanya kapan jadwal operasinya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien & istrinya mengeluh bila terlalu lama
me-nunggu karena keuangannya yang semakin meni-pis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Keluarga klien sudah mengurus JPS.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -1.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mau menunggu rencana operasi serta pasrah
dengan semua yang akan dilakukan terhadapnya.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien melaporkan perasaan cemasnya berkurang.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -1.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -1.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien tidak lagi menanyakan proses & kapan
pe-laksanaan operasi yang akan dilakukan.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien siap dioperasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -1.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien masih menyatakan siap menunggu jadwal operasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien menyatakan dapat tidur/istirahat malam ini.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -1.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: -1.7pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -8.3pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Kencing masih merah & menetes.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 6.6pt;">
Urine residu
> 80 cc.</div>
</td>
</tr>
</tbody></table>
</div>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: right;" />
</span>
<div class="WordSection8">
<div class="MsoTitle" style="line-height: 150%;">
CATATAN PERKEMBANGAN</div>
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NO.</div>
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TANGGAL</div>
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DIAGNOSA</div>
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CATATAN PERKEMBANGAN</div>
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1.</div>
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20-02-2002</div>
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21-02-2002</div>
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22-02-2002</div>
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1</div>
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1</div>
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2</div>
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1</div>
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<br /></div>
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3</div>
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S: Klien mengeluh lama menunggu operasi dilaksana-kan.</div>
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O:<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;"> </span>Operasi belum dilakukan/terjadwal.</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien gelisah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 32.0pt; mso-list: l18 level1 lfo16; tab-stops: list 36.0pt; text-indent: -14.0pt;">
<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien tampak kelelahan.</div>
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A:<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>Masalah belum teratasi.</div>
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<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>Teruskan rencana intervensi.</div>
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P:<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>Teruskan rencana intervensi.</div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -13.3pt;">
S: Klien menyatakan pasrah kapanpun operasi akan di<span style="mso-spacerun: yes;"> </span>lakukan.</div>
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O:<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>Operasi belum terjadwal.</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien sudah bisa tidur.</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Gelisah sudah jauh berkurang.</div>
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A:<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>Masalah teratasi sebagian, lemah belum teratasi.</div>
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P:<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;">
</span>Teruskan rencana intervensi. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
S:<span style="mso-spacerun: yes;"> </span>Klien mengatakan siap & pasrah untuk
dioperasi.</div>
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O: -<span style="mso-spacerun: yes;"> </span>Klien tidak lagi bertanya-tanya.</div>
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<span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span>Klien mau mendengarkan & melaksanakan saran untuk
makan & beristirahat yang cukup.</div>
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A: Masalah teratasi.</div>
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P: Intervensi tidak diteruskan.</div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
S: -</div>
<div class="MsoNormal" style="line-height: 150%;">
O: - Klien bisa istirahat.</div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="mso-spacerun: yes;"> </span>- Klein sudah tidak tampak gelisah.</div>
<div class="MsoNormal" style="line-height: 150%;">
A: Rencana teratasi.</div>
<div class="MsoNormal" style="line-height: 150%;">
P: Intervensi tidak diteruskan. </div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -13.3pt;">
S: Klien mengatakan kencingnya masih berwarna me-rah.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -13.3pt;">
O: - Warna kencing merah & berbau agak amis.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -13.3pt;">
<span style="mso-spacerun: yes;"> </span>- Produksi urine 24 jam <span style="font-family: Symbol; mso-ascii-font-family: "Times New Roman"; mso-char-type: symbol; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">±</span></span>
1500 ml.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -13.3pt;">
A: Masalah belum teratasi.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; text-indent: -13.3pt;">
P: Teruskan rencana intervensi.</div>
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<div class="MsoTitle" style="line-height: 150%;">
DAFTAR PUSTAKA</div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<div class="MsoTitle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-indent: -58.5pt;">
Black, Joyce M & Esther Matassarin-Jacobs.<span style="mso-spacerun: yes;"> </span>1997. <i>Medical Surgical Nursing : Clinical
Management for Continuity of Care</i>, Edisi 5, W.B. Saunders Company,
Philadelphia</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-indent: -58.5pt;">
Carpenito, Lynda Juall.<span style="mso-spacerun: yes;"> </span>2001.<span style="mso-spacerun: yes;"> </span><i>Buku Saku Diagnosa Keperawatan</i>.<span style="mso-spacerun: yes;"> </span>EGC.<span style="mso-spacerun: yes;">
</span>Jakarta.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-indent: -58.5pt;">
Doenges, Marilyn E, et all.<span style="mso-spacerun: yes;">
</span>1993.<span style="mso-spacerun: yes;"> </span><i>Nursing Care Plans :
Guidelines for Planning and Documenting Patient Care,</i> Edition 3, F.A. Davis
Company, Philadelphia. </div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-indent: -58.5pt;">
Gale, Danielle & Charette, Jane.<span style="mso-spacerun: yes;">
</span>2000.<span style="mso-spacerun: yes;"> </span><i>Rencana Asuhan
Keperawatan Onkologi</i>.<span style="mso-spacerun: yes;"> </span>EGC.<span style="mso-spacerun: yes;"> </span>Jakarta.</div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-indent: -58.5pt;">
Long, Barbara C.<span style="mso-spacerun: yes;"> </span>1996.<span style="mso-spacerun: yes;"> </span><i>Perawatan Medikal Bedah</i>. Alih Bahasa:
Yayasan Ikatan Alumni Pendidikan Keperawatan Pajajaran Bandung, Edisi 1,
Yayasan IAPK Pajajaran, Bandung.</div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com1tag:blogger.com,1999:blog-2019307917234147775.post-48941161806629502392011-11-10T06:30:00.001-08:002011-11-10T06:31:58.771-08:00askep AMI<!--[if !mso]>
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<br />
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: #0080ff; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"> ASuhan Keperawatan Infrak Miokard Akut</span></b></div>
<div class="MsoNormal" style="line-height: normal;">
<b><span style="color: #0080ff; font-size: 13.5pt;">Pengertian </span></b><b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"></span></b></div>
<ol start="1" type="1">
<li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Menurut
Brunner & Sudarth, 2002 infark miokardium mengacu pada proses rusaknya
jaringan jantung akibat suplai darah yang tidak adekuat sehingga aliran
darah koroner berkurang.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Sedangkan
pengertian menurut Suyono, 1999 infark miokard akut atau sering juga
disebut akut miokard infark adalah nekrosis miokard akibat aliran darah ke
otot jantung terganggu.</span></li>
</ol>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: #0080ff; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">Penyebab AMI</span></b><b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"></span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Menurut Kasuari, 2002 ada beberapa etiologi / penyebab
terjadinya infark miokard akut yaitu :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1) Faktor penyebab :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a) Berkurangnya suplai oksigen ke miokard yang disebabkan
oleh tiga faktor:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">i) Faktor pembuluh darah :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Aterosklerosis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Spasme</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Arteritis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">ii) Faktor sirkulasi:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hipotensi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Stenosis aorta</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Insufisiensi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">iii) Faktor darah:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Anemia</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hipoksemia</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Polisitemia</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b) Curah jantung yang meningkat:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Aktivitas yang berlebihan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Makan terlalu banyak</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Emosi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hipertiroidisme</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c) Kebutuhan oksigen miokard meningkat, pada:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kerusakan miokard</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hipertropimiokard</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hipertensi diastolik</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2) Faktor predisposisi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a) Faktor resiko biologis yang tidak dapat dirubah:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Umur lebih dari 40 tahun</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Jenis kelamin: insiden pada pria tinggi, sedangkan pada
wanita meningkat setelah menopause</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hereditas</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Ras: insiden pada kulit hitam lebih tinggi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b) Faktor resiko yang dapat dirubah:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">i) Mayor:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hipertensi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hiperlipidemia</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Obesitas</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Diabetes</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Merokok</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Diet: tinggi lemak jenuh, tinggi kalori</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">ii) Minor:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kepribadian tipe A (agresif, ambisius, emosional,
kompetitif)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Stress psikologis berlebihan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Inaktifitas fisik</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: #0080ff; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">Tanda dan Gejala</span></b><b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"></span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pada infark miokard dikenal istilah TRIAS, yaitu:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1. Nyeri :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a. Gejala utama adalah nyeri dada yang terjadi secara
mendadak dan terus-menerus tidak mereda, biasanya dirasakan diatas region
sternal bawah dan abdomen bagian atas.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b. Keparahan nyeri dapat meningkat secara menetap sampai
nyeri tidak tertahankan lagi.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c. Nyeri tersebut sangat sakit, seperti tertusuk-tusuk yang
dapat menjalar ke bahu dan terus ke bawah menuju lengan (biasanya lengan kiri).</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">d. Nyeri mulai secara spontan (tidak terjadi setelah
kegiatan atau gangguan emosional), menetap selama beberapa jam atau hari, dan
tidak hilang dengan bantuan istirahat atau nitrogliserin.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">e. Nyeri dapat menjalar ke arah rahang dan leher.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">f. Nyeri sering disertai dengan sesak nafas, pucat, dingin,
diaforesis berat, pening atau kepala terasa melayang dan mual muntah.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">g. Pasien dengan diabetes melitus tidak akan mengalami nyeri
yang hebat karena neuropati yang menyertai diabetes dapat mengganggu
neuroreseptord.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2. Laboratorium</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pemeriksaan enzim jantung :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a. CPK-MB/CPK</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Isoenzim yang ditemukan pada otot jantung meningkat antara
4-6 jam, memuncak dalam 12-24 jam, kembali normal dalam 36-48 jam.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b. LDH/HBDH</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Meningkat dalam 12-24 jam dam memakan waktu lama untuk
kembali normal</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c. AST/SGOT</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Meningkat ( kurang nyata / khusus ) terjadi dalam 6-12 jam,
memuncak dalam 24 jam, kembali normal dalam 3 atau 4 hari</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3. EKG</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Perubahan EKG yang terjadi pada fase awal adanya gelombang T
tinggi dan simetris. Setelah ini terdapat elevasi segmen ST. Perubahan yang
terjadi kemudian adalah adanya gelombang Q/QS yang menandakan adanya nekrosis.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: #0080ff; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">Pemeriksaan Penunjang</span></b><b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"></span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1.EKG</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Untuk mengetahui fungsi jantung. Akan ditemukan gelombang T
inverted, ST depresi, Q patologis.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2. Enzim Jantung.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">CPKMB, LDH, AST</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3.Elektrolit.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Ketidakseimbangan dapat mempengaruhi konduksi dan
kontraktilitas, misalnya hipokalemi, hiperkalemi.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">4.Sel darah putih</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Leukosit ( 10.000 – 20.000 ) biasanya tampak pada hari ke-2
setelah IMA berhubungan dengan proses inflamasi.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">5.Kecepatan sedimentasi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Meningkat pada hari ke-2 dan ke-3 setelah IMA , menunjukkan
inflamasi.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">6.Kimia</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Mungkin normal, tergantung abnormalitas fungsi atau perfusi
organ akut atau kronis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">7.GDA</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Dapat menunjukkan hypoksia atau proses penyakit paru akut
atau kronis.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">8.Kolesterol atau Trigliserida serum</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Meningkat, menunjukkan arteriosklerosis sebagai penyebab
IMA.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">9.Foto dada</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Mungkin normal atau menunjukkan pembesaran jantung diduga
GJK atau aneurisma ventrikuler.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">10.Ekokardiogram</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Dilakukan untuk menentukan dimensi serambi, gerakan katup
atau dinding ventrikuler dan konfigurasi atau fungsi katup.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">11.Pemeriksaan pencitraan nuklir</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a. Talium : mengevaluasi aliran darah miokard dan status sel
miokard misal lokasi atau luasnya AMI.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b. Technetium : terkumpul dalam sel iskemi di sekitar area
nekrotik</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">12.Pencitraan darah jantung (MUGA)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Mengevaluasi penampilan ventrikel khusus dan umum, gerakan
dinding regional dan fraksi ejeksi (aliran darah).</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">13.Angiografi koroner</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Menggambarkan penyempitan atau sumbatan arteri koroner.
Biasanya dilakukan sehubungan dengan pengukuran tekanan serambi dan mengkaji
fungsi ventrikel kiri (fraksi ejeksi). Prosedur tidak selalu dilakukan pad fase
AMI kecuali mendekati bedah jantung angioplasty atau emergensi.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">14.Nuklear Magnetic Resonance (NMR)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Memungkinkan visualisasi aliran darah, serambi jantung atau
katup ventrikel, lesivaskuler, pembentukan plak, area nekrosis atau infark dan
bekuan darah.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">15.Tes stress olah raga</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Menentukan respon kardiovaskuler terhadap aktifitas atau
sering dilakukan sehubungan dengan pencitraan talium pada fase penyembuhan.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: #0080ff; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">Penatalaksanaan</span></b><b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"></span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1. Rawat ICCU, puasa 8 jam</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2. Tirah baring, posisi semi fowler.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3. Monitor EKG</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">4. Infus D5% 10 – 12 tetes/ menit</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">5. Oksigen 2 – 4 lt/menit</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">6. Analgesik : morphin 5 mg atau petidin 25 – 50 mg</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">7. Obat sedatif : diazepam 2 – 5 mg</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">8. Bowel care : laksadin</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">9. Antikoagulan : heparin tiap 4 – 6 jam /infus</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">10. Diet rendah kalori dan mudah dicerna</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">11. Psikoterapi untuk mengurangi cemas</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"><a href="http://nursingbegin.com/pengkajian-keperawatan-3/" target="_blank" title="Pengkajian"><span style="color: #0080ff;">Pengkajian </span></a></span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">Pengkajian Primer</span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1. Airways</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a. Sumbatan atau penumpukan sekret</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b. Wheezing atau krekles</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2. Breathing</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a. Sesak dengan aktifitas ringan atau istirahat</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b. RR lebih dari 24 kali/menit, irama ireguler dangkal</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c. Ronchi, krekles</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">d. Ekspansi dada tidak penuh</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">e. Penggunaan otot bantu nafas</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3. Circulation</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">a. Nadi lemah , tidak teratur</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">b. Takikardi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">c. TD meningkat / menurun</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">d. Edema</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">e. Gelisah</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">f. Akral dingin</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">g. Kulit pucat, sianosis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">h. Output urine menurun</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">Pengkajian Sekunder</span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1. Aktifitas</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kelemahan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kelelahan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tidak dapat tidur</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Pola hidup menetap</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Jadwal olah raga tidak teratur</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tanda :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Takikardi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Dispnea pada istirahat atau aaktifitas.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2. Sirkulasi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala : riwayat IMA sebelumnya, penyakit arteri koroner,
masalah tekanan darah, diabetes mellitus.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tanda :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tekanan darah</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Dapat normal / naik / turun</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Perubahan postural dicatat dari tidur sampai duduk atau
berdiri.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Nadi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Dapat normal , penuh atau tidak kuat atau lemah / kuat
kualitasnya dengan pengisian kapiler lambat, tidak teratur (disritmia).</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Bunyi jantung</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Bunyi jantung ekstra : S3 atau S4 mungkin menunjukkan gagal
jantung atau penurunan kontraktilits atau komplain ventrikel.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Murmur</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Bila ada menunjukkan gagal katup atau disfungsi otot jantung</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Friksi ; dicurigai Perikarditis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Irama jantung dapat teratur atau tidak teratur</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Edema</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Distensi vena juguler, edema dependent , perifer, edema
umum, krekles mungkin ada dengan gagal jantung atau ventrikel.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Warna</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pucat atau sianosis, kuku datar , pada membran mukossa atau
bibir</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3. Integritas ego</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala : menyangkal gejala penting atau adanya kondisi takut
mati, perasaan ajal sudah dekat, marah pada penyakit atau perawatan, khawatir
tentang keuangan , kerja , keluarga.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tanda : menoleh, menyangkal, cemas, kurang kontak mata,
gelisah, marah, perilaku menyerang, fokus pada diri sendiri, koma nyeri.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">4. Eliminasi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tanda : normal, bunyi usus menurun.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">5. Makanan atau cairan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala : mual, anoreksia, bersendawa, nyeri ulu hati atau
rasa terbakar</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tanda : penurunan turgor kulit, kulit kering, berkeringat,
muntah, perubahan berat badan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">6. Higiene</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala atau tanda : lesulitan melakukan tugas perawatan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">7. Neurosensori</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala : pusing, berdenyut selama tidur atau saat bangun
(duduk atau istrahat )</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tanda : perubahan mental, kelemahan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">8. Nyeri atau ketidaknyamanan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Nyeri dada yang timbulnya mendadak (dapat atau tidak
berhubungan dengan aktifitas ), tidak hilang dengan istirahat atau
nitrogliserin (meskipun kebanyakan nyeri dalam dan viseral).</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Lokasi :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tipikal pada dada anterior, substernal , prekordial, dapat
menyebar ke tangan, ranhang, wajah. Tidak tertentu lokasinya seperti
epigastrium, siku, rahang, abdomen, punggung, leher.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kualitas :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">“Crushing ”, menyempit, berat, menetap, tertekan.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Intensitas :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Biasanya 10 (pada skala 1 -10), mungkin pengalaman nyeri
paling buruk yang pernah dialami.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Catatan</span></i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> : nyeri mungkin tidak ada pada
pasien pasca operasi, diabetes mellitus , hipertensi, lansia</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">9. Pernafasan:</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· dispnea saat aktivitas ataupun saat istirahat</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· dispnea nokturnal</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· batuk dengan atau tanpa produksi sputum</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· riwayat merokok, penyakit pernafasan kronis.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tanda :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· peningkatan frekuensi pernafasan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· nafas sesak / kuat</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· pucat, sianosis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· bunyi nafas ( bersih, krekles, mengi ), sputum</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">10. Interaksi sosial</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gejala :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Stress</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kesulitan koping dengan stressor yang ada misal : penyakit,
perawatan di RS</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tanda :</span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kesulitan
istirahat dengan tenang</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Respon
terlalu emosi ( marah terus-menerus, takut )</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Menarik
diri</span></li>
</ul>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes;"><img alt="askep-ima1" border="0" height="324" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.jpg" width="503" /></span><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes;"><img alt="askep-ima21" border="0" height="371" src="file:///C:/DOCUME%7E1/hazil/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.jpg" width="511" /></span><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;">
<b><span style="color: #0080ff; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">Diagnosa Keperawatan
dan Intervensi</span></b><b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"></span></b></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1. Nyeri berhubungan dengan iskemia jaringan sekunder
terhadap sumbatan arteri ditandai dengan :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· nyeri dada dengan / tanpa penyebaran</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· wajah meringis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· gelisah</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· delirium</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· perubahan nadi, tekanan darah.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tujuan :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Nyeri berkurang setelah dilakukan tindakan perawatan selama
di RS</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil:</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Nyeri dada berkurang misalnya dari skala 3 ke 2, atau dari
2 ke 1</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· ekpresi wajah rileks / tenang, tak tegang</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· tidak gelisah</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· nadi 60-100 x / menit,</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· TD 120/ 80 mmHg</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Intervensi :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Observasi
karakteristik, lokasi, waktu, dan perjalanan rasa nyeri dada.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Anjurkan
pada klien menghentikan aktifitas selama ada serangan dan istirahat.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Bantu
klien melakukan tehnik relaksasi, misalnya nafas dalam, perilaku
distraksi, visualisasi, atau bimbingan imajinasi.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pertahankan
oksigenasi dengan bikanul contohnya ( 2-4 L/ menit )</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Monitor
tanda-tanda vital ( nadi & tekanan darah ) tiap dua jam.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kolaborasi
dengan tim kesehatan dalam pemberian analgetik.</span></li>
</ul>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2. Resiko penurunan curah jantung berhubungan dengan
perubahan faktor-faktor listrik, penurunan karakteristik miokard.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tujuan : </span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Curah jantung membaik / stabil setelah dilakukan tindakan
keperawatan selama di RS.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tidak ada edema</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tidak ada disritmia</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Haluaran urin normal</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· TTV dalam batas normal</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Intervensi :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Pertahankan tirah baring selama fase akut</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kaji dan laporkan adanya tanda – tanda penurunan COP, TD</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Monitor haluaran urin</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kaji dan pantau TTV tiap jam</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kaji dan pantau EKG tiap hari</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Berikan oksigen sesuai kebutuhan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Auskultasi pernafasan dan jantung tiap jam sesuai indikasi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Pertahankan cairan parenteral dan obat-obatan sesuai advis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Berikan makanan sesuai diitnya</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hindari valsava manuver, mengejan ( gunakan laxan )</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3. Gangguan perfusi jaringan berhubungan dengan , iskemik,
kerusakan otot jantung, penyempitan / penyumbatan pembuluh darah arteri
koronaria ditandai dengan :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Daerah perifer dingin</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· EKG elevasi segmen ST & Q patologis pada lead tertentu</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· RR lebih dari 24 x/ menit</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kapiler refill lebih dari 3 detik</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Nyeri dada</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Gambaran foto torak terdpat pembesaran jantung &
kongestif paru ( tidak selalu )</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· HR lebih dari 100 x/menit, TD > 120/80 AGD dengan : pa
O<sub>2</sub> < 80 mmHg, pa CO<sub>2</sub> > 45 mmHg dan Saturasi < 80
mmHg</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Nadi lebih dari 100 x/ menit</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Terjadi peningkatan enzim jantung yaitu CK, AST, LDL/HDL</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tujuan :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Gangguan perfusi jaringan berkurang / tidak meluas selama
dilakukan tindakan perawatan di RS.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil:</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Daerah perifer hangat</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tidak sianosis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Gambaran EKG tak menunjukan perluasan infark</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· RR 16-24 x/ menit</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tidak terdapat clubbing finger</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kapiler refill 3-5 detik</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Nadi 60-100x / menit</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· TD 120/80 mmHg</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Intervensi :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Monitor Frekuensi dan irama jantung</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Observasi perubahan status mental</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Observasi warna dan suhu kulit / membran mukosa</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Ukur haluaran urin dan catat berat jenisnya</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kolaborasi : berikan cairan IV sesuai indikasi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Pantau pemeriksaan diagnostik / dan laboratorium misal
EKG, elektrolit , GDA (Pa O<sub>2</sub>, Pa CO<sub>2</sub> dan saturasi O<sub>2
</sub>). Dan pemberian oksigen</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">4. Resiko kelebihan volume cairan ekstravaskuler berhubungan
dengan penurunan perfusi ginjal, peningkatan natrium / retensi air ,
peningkatan tekanan hidrostatik, penurunan protein plasma.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tujuan :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Keseimbangan volume cairan dapat dipertahankan selama
dilakukan tindakan keperawatan di RS</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tekanan darah dalam batas normal</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tak ada distensi vena perifer/ vena dan edema dependen</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Paru bersih</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Berat badan ideal ( BB ideal TB -100 – 10 %)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Intervensi :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Ukur masukan / haluaran, catat penurunan , pengeluaran,
sifat konsentrasi, hitung keseimbangan cairan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Observasi adanya oedema dependen</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Timbang BB tiap hari</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Pertahankan masukan total cairan 2000 ml/24 jam dalam
toleransi kardiovaskuler</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kolaborasi : pemberian diet rendah natrium, berikan
diuretik.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">5. Kerusakan pertukaran gas berhubungan dengan gangguan
aliran darah ke alveoli atau kegagalan utama paru, perubahan membran alveolar-
kapiler ( atelektasis , kolaps jalan nafas/ alveolar edema paru/efusi, sekresi
berlebihan / perdarahan aktif ) ditandai dengan :</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Dispnea berat</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Gelisah</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Sianosis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Perubahan GDA</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Hipoksemia</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tujuan :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Oksigenasi dengan GDA dalam rentang normal (Pa O<sub>2</sub>
< 80 mmHg, Pa CO<sub>2</sub> > 45 mmHg dan Saturasi < 80 mmHg )
setelah dilakukan tindakan keperawatan selama di RS.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kriteria hasil :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tidak sesak nafas</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tidak gelisah</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· GDA dalam batas Normal ( Pa O<sub>2</sub> < 80 mmHg, Pa
CO<sub>2</sub> > 45 mmHg dan Saturasi < 80 mmHg )</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Intervensi :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Catat frekuensi & kedalaman pernafasan, penggunaan
otot bantu pernafasan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Auskultasi paru untuk mengetahui penurunan / tidak adanya
bunyi nafas dan adanya bunyi tambahan misal krakles, ronki dll.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Lakukan tindakan untuk memperbaiki / mempertahankan jalan
nafas misalnya , batuk, penghisapan lendir dll.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tinggikan kepala / tempat tidur sesuai kebutuhan /
toleransi pasien</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kaji toleransi aktifitas misalnya keluhan kelemahan/
kelelahan selama kerja atau tanda vital berubah.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">6. Intoleransi aktifitas berhubungan dengan
ketidakseimbangan antara suplai oksigen miokard dan kebutuhan, adanya iskemik/
nekrosis jaringan miokard ditandai dengan gangguan frekuensi jantung, tekanan
darah dalam aktifitas, terjadinya disritmia, kelemahan umum</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tujuan :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Terjadi peningkatan toleransi pada klien setelah
dilaksanakan tindakan keperawatan selama di RS</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Klien berpartisipasi dalam aktifitas sesuai kemampuan
klien</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Frekuensi jantung 60-100 x/ menit</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· TD 120-80 mmHg</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Intervensi :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Catat frekuensi jantung, irama, dan perubahan TD selama
dan sesudah aktifitas</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Tingkatkan istirahat ( di tempat tidur )</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Batasi aktifitas pada dasar nyeri dan berikan aktifitas
sensori yang tidak berat.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Jelaskan pola peningkatan bertahap dari tingkat aktifitas,
contoh bengun dari kursi bila tidak ada nyeri, ambulasi dan istirahat selam 1
jam setelah mkan.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kaji ulang tanda gangguan yang menunjukan tidak toleran
terhadap aktifitas atau memerlukan pelaporan pada dokter.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">7. Cemas berhubungan dengan ancaman aktual terhadap
integritas biologis</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tujuan :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Cemas hilang / berkurang setelah dilakukan tindakan
keperawatan selama di RS</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Klien
tampak rileks</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Klien
dapat beristirahat</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">TTV
dalam batas normal</span></li>
</ul>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Intervensi :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kaji tanda dan respon verbal serta non verbal terhadap
ansietas</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Ciptakan lingkungan yang tenang dan nyaman</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Ajarkan tehnik relaksasi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Minimalkan rangsang yang membuat stress</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Diskusikan dan orientasikan klien dengan lingkungan dan
peralatan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Berikan sentuhan pada klien dan ajak kllien
berbincang-bincang dengan suasana tenang</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Berikan support mental</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Kolaborasi pemberian sedatif sesuai indikasi</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">8. Kurang pengetahuan berhubungan dengan kurang informasi
tentang fungsi jantung / implikasi penyakit jantung dan status kesehatan yang
akan datang , kebutuhan perubahan pola hidup ditandai dengan pernyataan
masalah, kesalahan konsep, pertanyaan, terjadinya kompliksi yang dapat dicegah.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tujuan :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pengetahuan klien tentang kondisi penyakitnya menguat
setelah diberi pendidikan kesehatan selama di RS</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kriteria Hasil :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Menyatakan pemahaman tentang penyakit jantung , rencana
pengobatan, tujuan pengobatan & efek samping / reaksi merugikan</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Menyebutkan gangguan yang memerlukan perhatian cepat.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<b><i><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Intervensi :</span></i></b><span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Berikan informasi dalam bentuk belajar yang bervariasi,
contoh buku, program audio/ visual, tanya jawab dll.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Beri penjelasan faktor resiko, diet ( rendah lemak dan
rendah garam ) dan aktifitas yang berlebihan,</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Peringatan untuk menghindari aktifitas manuver valsava</span></div>
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<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">· Latih pasien sehubungan dengan aktifitas yang bertahap
contoh : jalan, kerja, rekreasi aktifitas seksual.</span></div>
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<br /></div>
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<b><span style="color: #0080ff; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">DAFTAR PUSTAKA</span></b><b><span style="font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"></span></b></div>
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<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1. Arif Mansjoer. <i>Kapita Selekta Kedokteran.</i> Jilid 1.
Jakarta : Media Aesculapius ; 2000</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2. Carolyn M. Hudak. <i>Critical Care Nursing : A Holistic
Approach.</i> Edisi VII. Volume II. Alih Bahasa : Monica E. D Adiyanti. Jakarta
: EGC ; 1997</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3. Corwin, E.J. <i>Handbook of pathophysiology</i>. Alih
bahasa : Pendit, B.U. Jakarta: EGC; 2001 (Buku asli diterbitkan tahun 1996)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">4. Doengoes, M.E., Moorhouse, M.F., Geissler, A.C. <i>Nursing
care plans: Guidelines for planning and documenting patients care.</i> Alih
bahasa: Kariasa, I.M. Jakarta: EGC; 1999 (Buku asli diterbitkan tahun 1993)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">5. Heni Rokhaeni, <i>Buku Ajar Keperawatan Kardiovaskuler</i>,
Edisi Pertama Jakarta, Bidang Diklat Pusat Kesehatan Jantung Dan Pembuluh Darah
Nasional Harapan Kita; 2002</span></div>
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<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">6. Kasuari, <i>Asuhan Keperawatan Sistem Pencernaan dan
Kardiovaskuler Dengan Pendekatan Patofisiology</i>, Magelang, Poltekes Semarang
PSIK Magelang, 2002</span></div>
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<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">7. Long, B.C. <i>Essential of medical – surgical nursing : A
nursing process approach</i>. Volume 2. Alih bahasa : Yayasan IAPK. Bandung:
IAPK Padjajaran; 1996 (Buku asli diterbitkan tahun 1989)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">8. Lynda Juall Carpenito. <i>Handbook Of Nursing Diagnosis</i>.
Edisi 8. Jakarta : EGC ; 2001</span></div>
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<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">9. Price, S.A. & Wilson, L.M. <i>Pathophysiology:
Clinical concept of disease processes</i>. 4<sup>th</sup> Edition. Alih bahasa
: Anugerah, P. Jakarta: EGC; 1994 (Buku asli diterbitkan tahun 1992)</span></div>
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<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">10. Sandra M. Nettina , <i>Pedoman Praktik Keperawatan</i>,
Jakarta, EGC, 2002</span></div>
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<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">11. Smeltzer, S.C. & Bare, B.G. <i>Brunner and
Suddarth’s textbook of medical – surgical nursing</i>. 8<sup>th</sup> Edition.
Alih bahasa : Waluyo, A. Jakarta: EGC; 2000 (Buku asli diterbitkan tahun 1996)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">12. Susan Martin Tucker. <i>Patient Care Standarts</i>.
Volume 2. Jakarta : EGC ; 1998</span></div>
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<span style="mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">13. Suyono, S, et al. <i>Buku ajar ilmu penyakit dalam</i>.
Edisi ketiga. Jakarta: Balai Penerbit FKUI; 2001</span></div>
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<br /></div>Maryadi hazilhttp://www.blogger.com/profile/18113574751033212280noreply@blogger.com0