tag:blogger.com,1999:blog-26958193623998013472024-03-12T18:57:00.299-07:00Hasgur STIKAYAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.comBlogger40125tag:blogger.com,1999:blog-2695819362399801347.post-88299530505615962422011-02-28T04:22:00.000-08:002011-02-28T04:22:50.725-08:00Askep Kanker Serviks<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: #45818e; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: #45818e; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">PENDAHULUAN</span></b></div><div class="MsoListParagraph" style="color: #45818e; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pendahuluan</span></b></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt; text-align: justify;">Kanker Leher Rahim (<em>Kanker Serviks</em>) adalah tumor ganas yang tumbuh di dalam leher rahim/<em>serviks</em> (bagian terendah dari rahim yang menempel pada puncak <em>vagina</em>. Kanker serviks biasanya menyerang wanita berusia 35-55 tahun. 90% dari kanker serviks berasal dari <em>sel skuamosa</em> yang melapisi serviks dan 10% sisanya berasal dari <em>sel kelenjar</em> penghasil lendir pada saluran servikal yang menuju ke dalam rahim. <sup>[4]</sup> Karsinoma serviks biasanya timbul pada zona transisional yang terletak antara epitel sel skuamosa dan epitel sel kolumnar.Hingga saat ini kanker serviks merupakan penyebab kematian terbanyak akibat penyakit kanker di negara berkembang. Sesungguhnya penyakit ini dapat dicegah bila program skrining sitologi dan pelayanan kesehatan diperbaiki. Diperkirakan setiap tahun dijumpai sekitar 500.000 penderita baru di seluruh dunia dan umumnya terjadi di negara berkembang.Penyakit ini berawal dari infeksi virus yang merangsang perubahan perilaku sel epitel serviks. Pada saat ini sedang dilakukan penelitian vaksinasi sebagai upaya pencegahan dan terapi utama penyakit ini di masa mendatang.Risiko terinfeksi virus HPV dan beberapa kondisi lain seperti perilaku seksual, kontrasepsi, atau merokok akan mempromosi terjadinya kanker serviks. Mekanisme timbulnya kanker serviks ini merupakan suatu proses yang kompleks dan sangat variasi hingga sulit untuk dipahami.Insiden dan mortalitas kanker serviks di dunia menempati urutan kedua setelah kanker payudara. sementara itu, di negara berkembang masih menempati urutan pertama sebagai penyebab kematian akibat kanker pada usia reproduktif. Hampir 80% kasus berada di negara berkembang. Sebelum tahun 1930, kanker servik merupakan penyebab utama kematian wanita dan kasusnya turun secara drastik semenjak diperkenalkannya teknik skrining pap smear oleh Papanikolau. Namun, sayang hingga kini program skrining belum lagi memasyarakat di negara berkembang, hingga mudah dimengerti mengapa insiden kanker serviks masih tetap tinggi.Hal terpenting menghadapi penderita kanker serviks adalah menegakkan diagnosis sedini mungkin dan memberikan terapi yang efektif sekaligus prediksi prognosisnya. Hingga saat ini pilihan terapi masih terbatas pada operasi, radiasi dan kemoterapi, atau kombinasi dari beberapa modalitas terapi ini. Namun, tentu saja terapi ini masih berupa “simptomatis” karena masih belum menyentuh dasar penyebab kanker yaitu adanya perubahan perilaku sel. Terapi yang lebih mendasar atau imunoterapi masih dalam tahap penelitian.Saat ini pilihan terapi sangat tergantung pada luasnya penyebaran penyakit secara anatomis dan senantiasa berubah seiring dengan kemajuan teknologi kedokteran. Penentuan pilihan terapi dan prediksi prognosisnya atau untuk membandingkan tingkat keberhasilan terapi baru harus berdasarkan pada perluasan penyakit. Secara universal disetujui penentuan luasnya penyebaran penyakit melalui sistem stadium. </div><div style="color: #45818e; line-height: 115%; text-align: justify;"><b>B. Tujuan</b></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan dari penulisan makalah ini yaitu untuk lebih memahami tentang Ca serviks, konsep medis Ca cerviks, serta Asuhan keperawatan Ca cerviks. </span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C. Rumusan masalah</span></b></div><div class="MsoNormal" style="color: #45818e; line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun rumusan masalah yang ada pada penulisan makalah ini, yaitu : </span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.Apa yang di maksud dengan Ca cerviks?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.Bagaimana etiologi Ca cerviks?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.Bagaimana klasifikasi klinis Ca cerviks?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.Bagaimana gejala klinis Ca cerviks?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.Bagaiman pemeriksaan diagnostik Ca cerviks?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%;"><span style="font-family: "Times New Roman","serif";">f. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaiman terapi Ca cerviks?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%;"><br />
</div><div align="center" style="color: #45818e; line-height: 115%; text-align: center;"><b><span style="font-size: 14pt; line-height: 115%;"><span> </span>BAB II</span></b></div><div align="center" style="color: #45818e; line-height: 115%; margin-left: 36pt; text-align: center;"><b><span style="font-size: 14pt; line-height: 115%;">PEMBAHASAN</span></b></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQZFsa_YW5cJSloqP_-kSVgcjcWUrwIFgrcSDN1RgYuZM3lGN_lJKHyUJ9Zf8Lf6yy0BAjOfpyedErdM95a4aUsm5s-GxGrpbZ6AOXKDiwntwes4zZ7MGWprpATwvDM44MjNW3N05YHc7o/s1600-h/kanker+serviks.jpg"><span style="text-decoration: none;"><span><img border="0" height="32" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="32" /></span></span></a><b><br />
A. Pengertian</b><br />
Kanker serviks adalah penyakit akibat tumor ganas pada daerah mulut rahim sebagai akibat dari adanya pertumbuhan jaringan yang tidak terkontrol dan merusak jaringan normal di sekitarnya .<br />
<b>B. Etiologi</b><br />
Penyebab kanker serviks belum jelas diketahui namun ada beberapa faktor resiko dan predisposisi yang menonjol, antara lain :<br />
a. Umur pertama kali melakukan hubungan seksual<br />
Penelitian menunjukkan bahwa semakin muda wanita melakukan hubungan seksual semakin besar mendapat kanker serviks. Kawin pada usia 20 tahun dianggap masih terlalu muda<br />
<span class="fullpost">b. Jumlah kehamilan dan partus</span><br />
<span class="fullpost">Kanker serviks terbanyak dijumpai pada wanita yang sering partus. Semakin sering partus semakin besar kemungkinan resiko mendapat karsinoma serviks.</span><br />
<span class="fullpost">c. Jumlah perkawinan</span><br />
<span class="fullpost">Wanita yang sering melakukan hubungan seksual dan berganti-ganti pasangan mempunyai faktor resiko yang besar terhadap kankers serviks ini.</span><br />
<span class="fullpost">d. Infeksi virus</span><br />
<span class="fullpost">Infeksi virus herpes simpleks (HSV-2) dan virus papiloma atau virus kondiloma akuminata diduga sebagai factor penyebab kanker serviks</span><br />
<span class="fullpost">e. Sosial Ekonomi</span><br />
<span class="fullpost">Karsinoma serviks banyak dijumpai pada golongan sosial ekonomi rendah mungkin faktor sosial ekonomi erat kaitannya dengan gizi, imunitas dan kebersihan perseorangan. Pada golongan sosial ekonomi rendah umumnya kuantitas dan kualitas makanan kurang hal ini mempengaruhi imunitas tubuh.</span><br />
<span class="fullpost">f. Hygiene dan sirkumsisi</span><br />
<span class="fullpost">Diduga adanya pengaruh mudah terjadinya kankers serviks pada wanita yang pasangannya belum disirkumsisi. Hal ini karena pada pria non sirkum hygiene penis tidak terawat sehingga banyak kumpulan-kumpulan smegma.</span><br />
<span class="fullpost">g. Merokok dan AKDR (alat kontrasepsi dalam rahim)</span><br />
<span class="fullpost">Merokok akan merangsang terbentuknya sel kanker, sedangkan pemakaian AKDR akan berpengaruh terhadap serviks yaitu bermula dari adanya erosi diserviks yang kemudian menjadi infeksi yang berupa radang yang terus menerus, hal ini dapat sebagai pencetus terbentuknya kanker serviks.</span><br />
<span class="fullpost"><b>C. Klasifikasi klinis</b></span><br />
<span class="fullpost">a. Stage 0: Ca.Pre invasif</span><br />
<span class="fullpost">b. Stage I: Ca. Terbatas pada serviks</span><br />
<span class="fullpost">c. Stage Ia ; Disertai inbasi dari stroma yang hanya diketahui secara histopatologis</span><br />
<span class="fullpost">d. Stage Ib : Semua kasus lainnya dari stage I</span><br />
<span class="fullpost">e. Stage II : Sudah menjalar keluar serviks tapi belum sampai kepanggul telah mengenai dinding vagina. Tapi tidak melebihi dua pertiga bagian proksimal</span><br />
<span class="fullpost">f. Stage III : Sudah sampai dinding panggula dan sepertiga bagian bawah vagina</span><br />
<span class="fullpost">g. Stage IIIB : Sudah mengenai organ-organ lain.</span><b><br />
<span class="fullpost">D. Gejala Klinis</span></b><br />
<span class="fullpost">a. Perdarahan</span><br />
<span class="fullpost">Sifatnya bisa intermenstruit atau perdarahan kontak, kadang-kadang perdarahan baru terjadi pada stadium selanjutnya. Pada jenis intraservikal perdarahan terjadi lambat.</span><br />
<span class="fullpost">b. Biasanya menyerupai air, kadang-kadang timbulnya sebelum ada perdarahan. Pada stadium lebih lanjut perdarahan dan keputihan lebih banyak disertai infeksi sehingga cairan yang keluar berbau.</span><b><br />
<span class="fullpost">E. Pemeriksaan diagnostik</span></b><br />
<span class="fullpost">a. Sitologi/Pap Smear</span><br />
<span class="fullpost">Keuntungan, murah dapat memeriksa bagian-bagian yang tidak terlihat.</span><br />
<span class="fullpost">Kelemahan, tidak dapat menentukan dengan tepat lokalisasi.</span><br />
<span class="fullpost">b. Schillentest</span><br />
<span class="fullpost">Epitel karsinoma serviks tidak mengandung glycogen karena tidak mengikat yodium. Kalau porsio diberi yodium maka epitel karsinoma yang normal akan berwarna coklat tua, sedang yang terkena karsinoma tidak berwarna.</span><br />
<span class="fullpost">c. Koloskopi</span><br />
<span class="fullpost">Memeriksa dengan menggunakan alat untuk melihat serviks dengan lampu dan dibesarkan 10-40 kali.</span><br />
<span class="fullpost">Keuntungan ; dapat melihat jelas daerah yang bersangkutan sehingga mudah untuk melakukan biopsy.</span><br />
<span class="fullpost">Kelemahan ; hanya dapat memeiksa daerah yang terlihat saja yaitu porsio, sedang kelianan pada skuamosa columnar junction dan intra servikal tidak terlihat.</span><br />
<span class="fullpost">d. Kolpomikroskopi</span><br />
<span class="fullpost">Melihat hapusan vagina (Pap Smear) dengan pembesaran sampai 200 kali</span><br />
<span class="fullpost">e. Biopsi</span><br />
<span class="fullpost">Dengan biopsi dapat ditemukan atau ditentukan jenis karsinomanya.</span><br />
<span class="fullpost">f. Konisasi</span><br />
<span class="fullpost">Dengan cara mengangkat jaringan yang berisi selaput lendir serviks dan epitel gepeng dan kelenjarnya. Konisasi dilakukan bila hasil sitologi meragukan dan pada serviks tidak tampak kelainan-kelainan yang jelas.</span><b><br />
<span class="fullpost">F. Terapi</span></b><br />
<span class="fullpost">a. Irradiasi</span><br />
<span class="fullpost">• Dapat dipakai untuk semua stadium</span><br />
<span class="fullpost">• Dapat dipakai untuk wanita gemuk tua dan pada medical risk</span><br />
<span class="fullpost">• Tidak menyebabkan kematian seperti operasi.</span><br />
<span class="fullpost">b. Dosis</span><br />
<span class="fullpost">Penyinaran ditujukan pada jaringan karsinoma yang terletak diserviks</span><br />
<span class="fullpost">c. Komplikasi irradiasi</span><br />
<span class="fullpost">• Kerentanan kandungan kencing</span><br />
<span class="fullpost">• Diarrhea</span><br />
<span class="fullpost">• Perdarahan rectal</span><br />
<span class="fullpost">• Fistula vesico atau rectovaginalis</span><br />
<span class="fullpost">d. Operasi</span><br />
<span class="fullpost">• Operasi Wentheim dan limfatektomi untuk stadium I dan II</span><br />
<span class="fullpost">• Operasi Schauta, histerektomi vagina yang radikal</span><br />
<span class="fullpost">e. Kombinasi</span><br />
<span class="fullpost">• Irradiasi dan pembedahan</span><br />
<span class="fullpost">Tidak dilakukan sebagai hal yang rutin, sebab radiasi menyebabkan bertambahnya vaskularisasi, odema. Sehingga tindakan operasi berikutnya dapat mengalami kesukaran dan sering menyebabkan fistula, disamping itu juga menambah penyebaran kesistem limfe dan peredaran darah.</span><br />
<span class="fullpost">f. Cytostatika : Bleomycin, terapi terhadap karsinoma serviks yang radio resisten. 5 % dari karsinoma serviks adalah resisten terhadap radioterapi, diangap resisten bila 8-10 minggu post terapi keadaan masih tetap sama.</span></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;"><span class="fullpost"></span></div><div align="center" style="color: #45818e; line-height: 150%; text-align: center;"><span class="fullpost"><b><span style="font-size: 14pt; line-height: 150%;">BAB III</span></b></span></div><div align="center" style="color: #45818e; line-height: 150%; margin-left: 36pt; text-align: center;"><span class="fullpost"><b><span style="font-size: 14pt; line-height: 150%;">ASUHAN KEPERAWATAN</span></b></span></div><div style="color: #45818e; line-height: 150%;"><span class="fullpost"><b><span style="font-size: 14pt; line-height: 150%;">A. </span></b></span><b>Pengkaijan </b><b><span style="font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Identitas klien.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Keluhan utama.<br />
Perdarahan dan keputihan</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. Riwayat penyakit sekarang</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien datang dengan perdarahan pasca coitus dan terdapat keputihan yang berbau tetapi tidak gatal. Perlu ditanyakan pada pasien atau keluarga tentang tindakan yang dilakukan untuk mengurangi gejala dan hal yang dapat memperberat, misalnya keterlambatan keluarga untuk memberi perawatan atau membawa ke Rumah Sakit dengan segera, serta kurangnya pengetahuan keluarga.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d. Riwayat penyakit terdahulu.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perlu ditanyakan pada pasien dan keluarga, apakah pasien pernah mengalami hal yang demikian dan perlu ditanyakan juga apakah pasien pernah menderita penyakit infeksi.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e. Riwayat penyakit keluarga</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perlu ditanyakan apakah dalam keluarga ada yang menderita penyakit seperti ini atau penyakit menular lain.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f. Riwayat psikososial<br />
Dalam pemeliharaan kesehatan dikaji tentang pemeliharaan gizi di rumah dan agaimana pengetahuan keluarga tentang penyakit kanker serviks.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Fisik</span></u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g. Inspeksi<br />
• Perdarahan<br />
• keputihan</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h. palpasi<br />
• nyeri abdomen<br />
• nyeri punggung bawah</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Dignostik</span></u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Sitologi</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Biopsi</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. Kolposkopi</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d. Servikografi</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e. Gineskopi</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f. Pap net (pemeriksaan terkumpoteresasi dengan hasil lebih sensitif).</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">B. Diagnosa Keperawatan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan perfusi jaringan berhubungan dengan anemia trombositopenia .</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nutrisi kurang dari kebutuhan tubuh berhubungan dengan anoreksia, mual dan muntah.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko tinggi terhadap infeksi berhubungan dengan imunosupresi</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi terhaap cedera berhubungan dengan trombositopenia.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Inteloransi aktifitas berhubungan dengan keletihan sekunder akibat anemia dan pemberian kemoterapi.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Koping individu tidak efektif berhubungan dengan diagnosa malignansi genokologis dan prognosis yang tak menentu.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan konsep diri (peran) berhubungan dengan dampakdiagnosis kanker terhadap peran pasien dalam keluarga.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurang pengetahuan tentang penatalaksanaan pengobatan berhubbungan dengan terbatasnya informasi.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C. Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan perfusi jaringan berhubungan dengan anemia trombositopenia .<br />
<i>Tujuan:<br />
</i>Mampu mengenali dan menangani anemia pencegahan terhadap terjadinya komplikasi perdarahan.<br />
<i>Intervensi :</i></span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam pemeriksaan hematokrit dan Hb serta jumlah trombosit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Berikan cairan secara cepat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pantau dan atur kecepatan infus.</span></div><div class="MsoListParagraphCxSpLast" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kolaborasi dalam pemberian infus</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b<i>. </i></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nutrisi kurang dari kebutuhan tubuh berhubungan dengan anoreksia, mual dan muntah.<br />
<i>Tujuan:<br />
</i>Masukan yang adekuat serta kalori yang mencukupi kebutuhan tubuh.<br />
<i>Intervensi:</i></span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji adanya pantangan atau adanya alergi terhadap makanan tertentu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kolaborasi dengan ahli gizi dalam pemberian menu yang sesuai dengan diet yang ditentukan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau masukan makanan oleh klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Anjurkan agar membawa makanan dari rumah jika dipelukan dan sesuai dengan diet.</span></div><div class="MsoListParagraphCxSpLast" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan perawatan mulut sebelum makan sesuai ketentuan.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko tinggi terhadap infeksi berhubungan dengan imunosupresi<br />
<i>Tujuan:<br />
</i>Potensial infeksi menurun dan tidak terdapat tanda-tanda infeksi.<br />
<i>Intervensi :</i></span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau tanda vital setiap 4 jam atau lebih sering bila diperlukan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tempatkan pasien pada lokasi yang tersedia.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu pasien dalam menjaga hygiene perorangan </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan pasien beristirahat sesuai kebutuhan.</span></div><div class="MsoListParagraphCxSpLast" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kolaborasi dalam pemeriksaan kultur dan pemberian antibiotika.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi terhaap cedera berhubungan dengan trombositopenia.<br />
<i>Tujuan:<br />
</i>Pasien bebas dari perdarahan dan hipoksis jaringan<br />
<i>Intervensi :</i></span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan petugas laboratorium untuk pemeriksaan darah lengkap (Hb dan Trombosit)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan tindakan yang tidak menyebabkan perdarahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Observasi tanda-tanda perdarahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi tanda-tanda vital.</span></div><div class="MsoListParagraphCxSpLast" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam tindakan transfusi TC ( Trombosit Concentrated)</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Inteloransi aktifitas berhubungan dengan keletihan sekunder akibat anemia dan pemberian kemoterapi.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan:<br />
</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien mampu mempertahankan tingkat aktifitas yang optimal.<br />
<i>Intervensi:</i></span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji pola istirahat serta adanya keletihan pasien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan kepada pasien untuk mempertahan pola istirahat atau tidur sebanyak mungkin dengan diimbangi aktifitas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu pasien merencanakanaktifitas berdasarkan pola istirahat atau keletihan yang dialami.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan kepada klien untuk melakukan latihan ringan.</span></div><div class="MsoListParagraphCxSpLast" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi kemampuan pasien dalam malakukan aktifitas.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Koping individu tidak efektif berhubungan dengan diagnosa malignansi genokologis dan prognosis yang tak menentu.<br />
<i>Tujuan:<br />
</i>Ansietas, kekuatiran dan kelemahan menurun sampai dengan pada tingkat dapat diatasi.<br />
<i>Intervensi:</i></span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gunakan pendekatan yang tenang dan cipakan suasana lingkungan yang kondusif.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi kempuan pasien dalam mengambil keputusan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dorong harapan yang realistis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dukung penggunaan mekanisme pertahanan diri yang sesuai.</span></div><div class="MsoListParagraphCxSpLast" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 38.25pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan dorongan spiritual.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan konsep diri (peran) berhubungan dengan dampakdiagnosis kanker terhadap peran pasien dalam keluarga.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien dapat mengungkapkan dampak dari diagnosa kanker terhadap perannya dan mendemontrasikan kemampuan untuk menghadapi perubahan peran.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu pasien untuk mengedintifikasi peran yang bisa dilakukan didalam keluarga dan komunitasnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu pasien untuk mengidentifikasi perubahan fisik yang spesifik yang dibutuhkan sehubungan dengan penyakitnya.</span></div><div class="MsoListParagraphCxSpLast" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diskusikan dengan keluarga untuk berkompensasi terhadap perubahan peran anggota yang sakit.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurang pengetahuan tentang penatalaksanaan pengobatan berhubungan dengan terbatasnya informasi.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan :<br />
</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien dapat mengungkapkan perencanaan pengobatan tujuan dari pemberian terapi.<br />
<i>Intervensi:</i></span></div><div class="MsoListParagraphCxSpFirst" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Baringkan pasien diatas tempat tidur.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji kepatenan kateter abdomen.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi tentang reaksi yang dialami pasien selama pengobatan</span></div><div class="MsoListParagraphCxSpLast" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jelaskan pada pasien efek yang mungkin dapat terjadi.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">D. Evaluasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-bottom: 0.0001pt; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil yang diharapkan dari tindakan keperawatan adalah :</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Mampu mengenali dan menangani anemia pencegahan terhadap terjadinya komplikasi perdarahan.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Kebutuhan Nutrisi dan Kalori pasein tercukupi kebutuhan tubuh</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. Tidak ada tanda-tanda infeksi</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d. Pasien bebas dari perdarahan dan hipoksis jaringan</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e. Pasien mampu mempertahankan tingkat aktifitas yang optimal.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f. Ansietas, kekuatiran dan kelemahan menurun sampai dengan pada tingkat dapat diatasi.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g. Pasien dapat mengungkapkan dampak dari diagnosa kanker terhadap perannya dan mendemontrasikan kemampuan untuk menghadapi perubahan peran.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h. Pasein dapat mengungkapkan perencanaan pengobatan tujuan dari pemberian terapi</span></div><div align="center" style="color: #45818e; line-height: 150%; margin-left: 252pt; text-align: center;"><b> <span style="font-size: 14pt; line-height: 150%;"> </span></b></div><div align="center" style="color: #45818e; line-height: 150%; margin-left: 36pt; text-align: center;"><b><span style="font-size: 14pt; line-height: 150%;">BAB IV</span></b></div><div align="center" style="color: #45818e; line-height: 150%; margin-left: 36pt; text-align: center;"><b><span style="font-size: 14pt; line-height: 150%;">PENUTUP</span></b></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt; text-indent: -18pt;"><b><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Kesimpulan</b><b><span style="font-size: 14pt; line-height: 150%;"></span></b></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;">Berdasarkan uraian diatas, maka dapat disimpulkan sebagai berikut :</div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;">Kanker serviks adalah penyakit akibat tumor ganas pada daerah mulut rahim sebagai akibat dari adanya pertumbuhan jaringan yang tidak terkontrol dan merusak jaringan normal di sekitarnya .</div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;">Penyebab kanker serviks belum jelas diketahui namun ada beberapa faktor resiko dan predisposisi yang menonjol, antara lain :<br />
a. Umur pertama kali melakukan hubungan seksual</div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;"><span class="fullpost">b. Jumlah kehamilan dan partus</span></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;"><span class="fullpost">c. Jumlah perkawinan</span></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;"><span class="fullpost">d. Infeksi virus</span></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;"><span class="fullpost">e. Sosial Ekonomi</span></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;"><span class="fullpost">f. Hygiene dan sirkumsisi</span></div><div style="color: #45818e; line-height: 150%; margin-left: 36pt;"><span class="fullpost">g. Merokok dan AKDR (alat kontrasepsi dalam rahim)</span></div><div style="color: #45818e; line-height: 150%;"><span class="fullpost"><b>B. Saran</b></span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; text-align: justify;">Bagi mahasiswa keperawatan diharapkan dapat mengerti konsep Ca serviks serta dapat<span> </span>melaksanakan asuhan keperawatan sesuai dengan prosedur yang ada.</div><div class="MsoNormal" style="color: #45818e; line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: #45818e; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DAFTAR PUSTAKA</span></b></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Blogs Noenk. Carcinoma Cervix Uteri. Didapatkan dari URL : <span>http://ca cervix/NOENk BLOGs » Blog Archive » CARCINOMA CERVIX UTERI.mht.</span> Diunduh tanggal 11 Oktober 2008. (Diakses tanggal 4 Desember 2010)</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Edianto Deri. Kanker Serviks. Dalam Aziz Farid M, Andrijono, Saifuddin AB. Buku Acuan Nasional Onkologi dan Ginekologi. Yayasan Bina Pustaka Sarwono Prawirahardjo. Jakarta, 2006; 33: 442-455.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lawalangy Jejak, Wuto Koemo, Liwu Sumanomo. Kanker Serviks. Didapatkan dari URL : <span>http:/ca cervix/Hasil Penelusuran Gambar Google untuk http–upload_wikimedia_org-wikipedia-commons-e-e3-Fem_isa_2_gif.mht.</span> Diunduh tanggal 11 Oktober 2008. (Diakses tanggal 4 Desember 2010)</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mardjikoen Praswoto. Tumor Ganas Alat Genital, subbagian Karsinoma Servisis Uteri. Dalam Ilmu Kandungan ed.2. Yayasan Bina Pustaka Sarwono Prawirahardjo. Jakarta, 1999; 14:380-390.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ocviyanti Dwiana. HPV dan Kanker Serviks. Power Point IVA. Jakarta,2008.</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">O’Hanlan Kate. Carcinoma of the Cervix Uteri. Didapatkan dari URL : <span>http:/ca cervix/Displasia of the Cervix.mht.</span> Diunduh tanggal 11 Oktober 2008. (Diakses tanggal 4 Desember 2010)</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rohmat Ratih. Penanganan CA Cervix. Didapatkan dari URL : <span>http://ca cervix/Penanganan CA Cervix « Ratihrochmat’s Weblog.mht.</span> Diunduh tanggal 11 Oktober 2008. (Diakses tanggal 4 Desember 2010)</span></div><div class="MsoNormal" style="color: #45818e; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Wikipedia. Cervical Cancer. Didapatkan dari URL : <span>http://en.wikipedia.org/wiki/ca cervix/Cervical cancer – Wikipedia, the free encyclopedia.htm</span>. Diunduh tanggal 11 Oktober<span> </span>2008. (Diakses tanggal 4 Desember 2010)</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-66442802702986212452011-02-28T04:15:00.000-08:002011-02-28T04:15:38.150-08:00Askep Kanker Ovarium<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><br />
</div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; line-height: 150%;">I.I<span> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">LATAR BELAKANG</span></b></div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 18pt;">Sistem reprodukdi wanita terdiri dari vagina, tuba fallopi, sepasang ovarium, dan uterus. Setiap bulan, pada wanita usia subur, salah satu ovarium menghasilkan telur. Telur lolos ke tuba fallopi ke dalam rahim (uterus). Jika telur tidak dibuahi oleh sperma yang lolos keluar dari rahim dan gudang, bersama dengan lapisan rahim, sebagai bagian dari periode bulanan. </div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 18pt;">Ovarium juga memproduksi hormon seks wanita, estrogen dan progesteron. Sebagai seorang wanita mendekati menopause ('perubahan hidup') indung telur membuat kurang hormon-hormon ini, dan periode secara bertahap berhenti.</div><div style="color: #3d85c6; line-height: 150%;"><span> </span><span>organ lainnya sangat dekat dengan indung telur (lihat diagram di bawah). Ini termasuk: </span></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Ureter, yang mengalirkan urin dari ginjal ke kandung kemih. </span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kandung kemih. </span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Belakang (dubur). </span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Bagian bawah dari usus kecil. </span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">The omentum (membran yang mengelilingi semua organ panggul dan perut dan menjaga mereka di tempat). It is also called the peritoneum. Hal ini juga disebut peritoneum. </span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kelompok kelenjar getah bening. </span></li>
</ul><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: center;"><span style="font-family: "Times New Roman","serif";"><img height="252" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.jpg" width="381" /></span><span style="font-family: "Times New Roman","serif";"></span></div><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: center;"><i><span style="font-family: "Times New Roman","serif";">Gambar I. Ovarium dan struktur sekitarnya</span></i></div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;">Setiap tahun, sekitar 6600 wanita di Inggris yang didiagnosis dengan kanker ovarium. Penyebab belum sepenuhnya dipahami, tetapi beberapa faktor (yang dikenal sebagai <a href="http://translate.googleusercontent.com/translate_c?hl=id&langpair=en%7Cid&u=http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Ovary/Aboutovariancancer/Causesandriskfactors.aspx&rurl=translate.google.co.id&usg=ALkJrhgDQA2HPFpyNGbyKYj4pm8ij7T3ow#Riskfactors" title="Penyebab dan faktor risiko"><span style="text-decoration: none;">faktor risiko</span></a> <span style="display: none;">|)</span> yang diyakini dapat meningkatkan kesempatan wanita mengembangkan kanker ovarium epithelial, yang umum jenis yang paling. </div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Seperti banyak kanker, faktor risiko utama untuk kanker ovarium adalah umur (yang di atas usia 50). Risiko mengembangkan kanker ovarium sangat rendah pada wanita muda dan meningkat sebagai perempuan semakin tua. Kanker ovarium terjadi pada wanita di atas usia 50. Sebagian besar kanker ovarium terjadi pada wanita yang telah menopause mereka.</span><span style="font-family: "Times New Roman","serif"; line-height: 150%;"></span></div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;">Faktor-faktor risiko yang mungkin terjadi adalah sejarah keluarga yang kuat kanker ovarium atau payudara, obesitas, penggunaan terapi hormon pengganti (Hormone Replacement Therapy), dan infertilitas dan perawatan kesuburan. </div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;">Penelitian telah menunjukkan bahwa obat yang digunakan dalam perawatan kesuburan sedikit dapat meningkatkan resiko kanker ovarium. Ini juga telah menyarankan bahwa ia sedang subur yang meningkatkan risiko kanker ovarium, daripada pengobatan apa pun yang mungkin Anda miliki untuk itu. Ada penelitian lebih lanjut akan untuk mencoba mengklarifikasi ini.</div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;">Faktor lain (disebut <a href="http://translate.googleusercontent.com/translate_c?hl=id&langpair=en%7Cid&u=http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Ovary/Aboutovariancancer/Causesandriskfactors.aspx&rurl=translate.google.co.id&usg=ALkJrhgDQA2HPFpyNGbyKYj4pm8ij7T3ow#Protectivefactors" title="Penyebab dan faktor risiko"><span style="text-decoration: none;">faktor protektif</span></a> <span style="display: none;">|)</span> dapat mengurangi risiko perempuan terkena kanker ovarium seperti memiliki anak, menggunakan pil kontrasepsi dan menyusui. Perempuan yang belum punya anak sedikit lebih mungkin mengembangkan kanker ovarium dibandingkan wanita yang memiliki, meski risiko masih sangat rendah.</div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;">Hanya sejumlah kecil (sekitar 5-10 dalam 100) dari kanker ovarium dianggap disebabkan oleh <a href="http://translate.googleusercontent.com/translate_c?hl=id&langpair=en%7Cid&u=http://www.macmillan.org.uk/Cancerinformation/Causesriskfactors/Genetics/Cancergenetics/Cancerandgenes.aspx&rurl=translate.google.co.id&usg=ALkJrhiuVbfbUwvMWbKYIruEVuNz--NLtw" title="Kanker dan gen"><span style="text-decoration: none;">gen yang rusak</span></a> <span style="display: none;">|</span> yang berjalan di dalam keluarga itu. Wanita yang memiliki <a href="http://translate.googleusercontent.com/translate_c?hl=id&langpair=en%7Cid&u=http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Breast/Breastcancer.aspx&rurl=translate.google.co.id&usg=ALkJrhjJ5nichgi6U5EXRxO6xM3FuoymRg" title="Kanker payudara"><span style="text-decoration: none;">kanker payudara</span></a> <span style="display: none;">|</span> memiliki peningkatan risiko kanker ovarium. Hal ini karena payudara dan kanker ovarium dapat disebabkan oleh gen yang rusak sama. </div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;">Sebuah <a href="http://translate.googleusercontent.com/translate_c?hl=id&langpair=en%7Cid&u=http://www.macmillan.org.uk/Cancerinformation/Causesriskfactors/Genetics/Areyouworriedabout/ovariancancer.aspx&rurl=translate.google.co.id&usg=ALkJrhiei7RNy5gPCbXuaUgRdmKh1pW1mw#ovarian_family_history"><span style="text-decoration: none;">sejarah keluarga yang kuat</span></a> <span style="display: none;">|</span> dari ovarium, payudara atau kanker usus juga bisa berarti ada gen rusak dalam keluarga Anda. Namun, setelah satu atau bahkan dua anggota keluarga dengan kanker tidak selalu berarti Anda membawa gen warisan yang salah, dan membawa gen yang rusak tidak berarti Anda pasti akan mendapatkan kanker. </div><div style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;">Jika Anda prihatin tentang riwayat keluarga kanker ovarium, mungkin juga akan bermanfaat untuk membaca makalah kami tentang kanker ovarium. Selain untu pembaca umum, makalah yang kami tulis ini juga di tujukan khususnya untuk memenuhi tugas kami pada mata kuliah <b><i>Keprawatan Maternitas. </i></b>Semoga makalah kami ini dapat berguna bagi pembaca pada umumnya dan bagi mahasiswa S1 Keperawatan STIK Avicenna pada khususnya.</div><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin-bottom: 10pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin-bottom: 10pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PEMBAHASAN</span></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">II.I<span> </span>DEFINISI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Kanker ovarium adalah tumor ganas pada ovarium (indung telur) yang paling sering ditemukan pada wanita berusia 50 – 70 tahun. Kanker ovarium bisa menyebar ke bagian lain, panggul, dan perut melalui sistem getah bening dan melalui sistem pembuluh darah menyebar ke hati dan paru-paru.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Kanker ovarium sangat sulit didiagnosa dan kemungkinan kanker ovarium ini merupakan awal dari banyak kanker primer. (Wingo, 1995)</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">II.II<span> </span>ETIOLOGI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif";">Penyebab kanker ovarium belum diketahui secara pasti. Akan tetapi banyak teori yang menjelaskan tentang etiologi kanker ovarium, diantaranya:</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin-left: 18pt; text-indent: -18pt;"><b><i><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i></b><b><i><span style="font-family: "Times New Roman","serif";">Hipotesis incessant ovulation</span></i></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Teori menyatakan bahwa terjadi kerusakan pada sel-sel epitel ovarium untuk penyembuhan luka pada saat terjadi ovulasi. Proses penyembuhan sel-sel epitel yang terganggu dapat menimbulkan proses transformasi menjadi sel-sel tumor.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">2. Hipotesis androgen</span></i></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Androgen mempunyai peran penting dalam terbentuknya kanker ovarium. Hal ini didasarkan pada hasil percobaan bahwa epitel ovarium mengandung reseptor androgen. Dalam percobaan in-vitro, androgen dapat menstimulasi pertumbuhan epitel ovarium normal dan sel-sel kanker ovarium.</span> </div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">II.III<span> </span>PATOFISIOLOGI</span></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Setiap hari, ovarium normal akan membentuk beberapa kista kecil yang disebut Folikel de Graff. Pada pertengahan siklus, folikel dominan dengan diameter lebih dari 2.8 cm akan melepaskan oosit mature. Folikel yang rupture akan menjadi korpus luteum, yang pada saat matang memiliki struktur 1,5 – 2 cm dengan kista ditengah-tengah. Bila tidak terjadi fertilisasi pada oosit, korpus luteum akan mengalami fibrosis dan pengerutan secara progresif. Namun bila terjadi fertilisasi, korpus luteum mula-mula akan membesar kemudian secara gradual akan mengecil selama kehamilan.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Kista ovari yang berasal dari proses ovulasi normal disebut kista fungsional dan selalu jinak. Kista dapat berupa folikular dan luteal yang kadang-kadang disebut kista theca-lutein. Kista tersebut dapat distimulasi oleh gonadotropin, termasuk FSH dan HCG. Kista fungsional multiple dapat terbentuk karena stimulasi gonadotropin atau sensitivitas terhadap gonadotropin yang berlebih. </span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Pada neoplasia tropoblastik gestasional (hydatidiform mole dan choriocarcinoma) dan kadang-kadang pada kehamilan multiple dengan diabetes, HCg menyebabkan kondisi yang disebut hiperreaktif lutein. Pasien dalam terapi infertilitas, induksi ovulasi dengan menggunakan gonadotropin (FSH dan LH) atau terkadang clomiphene citrate, dapat menyebabkan sindrom hiperstimulasi ovari, terutama bila disertai dengan pemberian HCG.<br />
Kista neoplasia dapat tumbuh dari proliferasi sel yang berlebih dan tidak terkontrol dalam ovarium serta dapat bersifat ganas atau jinak. Neoplasia yang ganas dapat berasal dari semua jenis sel dan jaringan ovarium. Sejauh ini, keganasan paling sering berasal dari epitel permukaan (mesotelium) dan sebagian besar lesi kistik parsial. Jenis kista jinak yang serupa dengan keganasan ini adalah kistadenoma serosa dan mucinous. Tumor ovari ganas yang lain dapat terdiri dari area kistik, termasuk jenis ini adalah tumor sel granulosa dari sex cord sel dan germ cel tumor dari germ sel primordial. Teratoma berasal dari tumor germ sel yang berisi elemen dari 3 lapisan germinal embrional; ektodermal, endodermal, dan mesodermal.<br />
Endometrioma adalah kista berisi darah dari endometrium ektopik.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">II. IV TANDA & GEJALA</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">Gejala umum bervariasi dan tidak spesifik. Pada stadium awal berupa :</span></i></b></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">haid tidak teratur</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">ketegangan menstrual yang terus meningkat</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">menoragia</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">nyeri tekan pada payudara</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">menopause dini</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">rasa tidak nyaman pada abdomen</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">dispepsia</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">tekanan pada pelvis</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">sering berkemih</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">flatulenes</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">rasa begah setelah makan makanan kecil</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">lingkar abdomen yang terus meningkat</span></li>
</ul><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">II.V<span> </span>STADIUM</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Stadium kanker ovarium primer menurut FIGO (Federation International of Ginecologies and Obstetricians ) 1987, adalah :</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">STADIUM <span> </span>I </span></i></b><b><i><span style="font-family: "Times New Roman","serif";"><span> </span>–> <span> </span>pertumbuhan terbatas pada ovarium</span></i></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif";">1. Stadium 1a :</span></b><span style="font-family: "Times New Roman","serif";"> pertumbuhan terbatas pada suatu ovarium, tidak ada asietas yang berisi sel ganas, tidak ada pertumbuhan di permukaan luar, kapsul utuh.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">2. Stadium 1b :</span></b><span style="font-family: "Times New Roman","serif";"> pertumbuhan terbatas pada kedua ovarium, tidak asietas, berisi sel ganas, tidak ada tumor di permukaan luar, kapsul intak.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">3. Stadium 1c :</span></b><span style="font-family: "Times New Roman","serif";"> tumor dengan stadium 1a dan 1b tetapi ada tumor dipermukaan luar atau kedua ovarium atau kapsul pecah atau dengan asietas berisi sel ganas atau dengan bilasan peritoneum positif.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify;"><b><i><span style="font-family: "Times New Roman","serif";">STADIUM <span> </span>II </span></i></b><b><i><span style="font-family: "Times New Roman","serif";"><span> </span>–> <span> </span>Pertumbuhan pada satu atau dua ovarium dengan perluasan ke panggul</span></i></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">1. Stadium 2a :</span></b><span style="font-family: "Times New Roman","serif";"> perluasan atau metastasis ke uterus dan atau tuba</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">2. Stadium 2b :</span></b><span style="font-family: "Times New Roman","serif";"> perluasan jaringan pelvis lainnya</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">3. Stadium 2c :</span></b><span style="font-family: "Times New Roman","serif";"> tumor stadium 2a dan 2b tetapi pada tumor dengan permukaan satu atau kedua ovarium, kapsul pecah atau dengan asitas yang mengandung sel ganas dengan bilasan peritoneum positif.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify;"><b><i><span style="font-family: "Times New Roman","serif";">STADIUM <span> </span>III</span></i></b><b><i><span style="font-family: "Times New Roman","serif";"> –> tomor mengenai satu atau kedua ovarium dengan implant di peritoneum di luar pelvis dan atau retroperitoneal positif. Tumor terbatas dalam pelvis kecil tetapi sel histologi terbukti meluas ke usus besar atau omentum.</span></i></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">1. Stadium 3a :</span></b><span style="font-family: "Times New Roman","serif";"> tumor terbatas di pelvis kecil dengan kelenjar getah bening negatif tetapi secara histologi dan dikonfirmasi secara mikroskopis terdapat adanya pertumbuhan (seeding) dipermukaan peritoneum abdominal.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">2. Stadium 3b :</span></b><span style="font-family: "Times New Roman","serif";"> tumor mengenai satu atau kedua ovarium dengan implant dipermukaan peritoneum dan terbukti secara mikroskopis, diameter melebihi 2 cm, dan kelenjar getah bening negativ.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">3. Stadium 3c :</span></b><span style="font-family: "Times New Roman","serif";"> implant di abdoment dengan diameter > 2 cm dan atau kelenjar getah bening retroperitoneal atau inguinal positif.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify;"><b><i><span style="font-family: "Times New Roman","serif";">STADIUM IV</span></i></b><b><i><span style="font-family: "Times New Roman","serif";"> –> pertumbuhan mengenai satu atau kedua ovarium dengan metastasis jauh. Bila efusi pleura dan hasil sitologinya positif dalam stadium 4, begitu juga metastasis ke permukaan liver.</span></i></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">II. VI<span> </span>PENEGAKAN DIAGNOSA</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Sebagian besar kanker ovarium bermula dari suatu kista. Oleh karena itu, apabila pada seorang wanita ditemukan suatu kista ovarium harus dilakukan pemeriksaan lebih lanjut untuk menentukan apakah kista tersebut bersifat jinak atau ganas (kanker ovarium).</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">Ciri2 kista yang bersifat ganas yaitu pada keadaan :</span></i></b></div><ol start="1" style="color: #3d85c6;" type="1"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kista cepat membesar</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kista pada usia remaja atau pascamenopause</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kista dengan dinding yang tebal dan tidak berurutan</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kista dengan bagian padat</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Tumor pada ovarium</span></li>
</ol><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">Pemeriksaan lanjutan untuk memperkuat dugaan ke arah kanker ovarium seperti :</span></i></b></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">USG dengan Doppler untuk menentukan arus darah</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Jika diperlukan, pemeriksaan CT-Scan/ MRI</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Pemeriksaan tumor marker seperti Ca-125 dan Ca-724, beta – HCG dan alfafetoprotein</span></li>
</ul><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif";">Semua pemeriksaan belum bisa memastikan diagnosis kanker ovarium, akan tetapi hanya sebagai pegangan untuk melakukan tindakan operasi.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">II.VII<span> </span>PENATAKLASANAAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Sebagian besar kanker ovarium memerlukan pengobatan dengan kemoterapi. Hanya kanker ovarium stadium awal saja (stadium 1a dan 1b dengan derajat diferensiasi sel yang baik/sedang) yang tidak memerlukan kombinasi pengobatan. Kemoterapi diberikan sebanyak 6 seri dengan interval 3 – 4 minggu sekali dengan melakukan pemantauan terhadap efeh samping kemoterapi secara berkala terhadap sumsum tulang, fungsi hati, fungsi ginjal, sistem saluran cerna, sistem saluran cerna, sistem saraf dan sistem kardiovaskuler.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">Penatalaksanaan yang sesuai dengan stadium yaitu :</span></i></b></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Operasi (stadium awal)</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kemoterapi (tambahan terapi pada stadium awal)</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Radiasi (tambahan terapi untuk stadium lanjut)</span></li>
</ul><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">KONSEP ASUHAN KEPERAWATAN</span></b></div><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; text-align: center;"><br />
</div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">III.I<span> </span>PENGKAJIAN</span></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><span style="font-family: "Times New Roman","serif";"><span> </span>Hal-hal yang perlu di kaji pada klien adalah :</span><span style="font-family: "Times New Roman","serif";"></span></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Data diri klien</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Data biologis/fisiologis –> keluhan utama, riwayat keluhan utama</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Riwayat kesehatan masa lalu</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Riwayat kesehatan keluarga</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Riwayat reproduksi –> siklus haid, durasi haid</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Riwayat obstetric –> kehamilan, persalinan, nifas, hamil</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Pemeriksaan fisik</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Data psikologis/sosiologis–> reaksi emosional setelah penyakit diketahui</span></li>
</ul><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">III.II<span> </span>DIAGNOSA KEPERAWATAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;"></span></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">Nyeri akut</span></i></b><span style="font-family: "Times New Roman","serif";"> b.d agen cidera biologi</span></li>
<li class="MsoNormal" style="line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">Perubahan citra tubuh dan harga diri</span></i></b><span style="font-family: "Times New Roman","serif";"> b.d perubahan dalam penampilan fungsi dan peran</span></li>
<li class="MsoNormal" style="line-height: 150%;"><b><i><span style="font-family: "Times New Roman","serif";">Risiko tinggi terhadap disfungsi seksual</span></i></b><span style="font-family: "Times New Roman","serif";"> b.d perubahan struktur atau fungsi tubuh, perubahan kadar hormone</span></li>
</ul><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 13pt; line-height: 150%;">III.III<span> </span>TUJUAN & INTERVENSI</span></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Diagnosa 1 : Nyeri akut b.d agen cidera biologi</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Tujuan : </span></b><span style="font-family: "Times New Roman","serif";">Klien merasa reda dari nyeri dan ketidaknyamanan yang ditimbulkan</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Intervensi :</span></b><span style="font-family: "Times New Roman","serif";"></span></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kaji karakteristik nyeri : lokasi, kualitas, frekuensi</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kaji faktor lain yang menunjang nyeri, keletihan, marah pasien</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kolaborasi dengan tim medis dalam memberi obat analgesic</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Jelaskan kegunaan analgesic dan cara-cara untuk mengurangi efek samping</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Ajarkan klien strategi baru untuk meredakan nyeri dan ketidaknyamanan: imajinasi, relaksasi, stimulasi kutan</span></li>
</ul><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Diagnosa 2 : Perubahan citra tubuh dan harga diri b.d perubahan dalam penampilan fungsi dan peran</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Tujuan : </span></b><span style="font-family: "Times New Roman","serif";">Klien dapat memperbaiki persepsi citra tubuh dan harga dirinya.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Intervensi :</span></b><span style="font-family: "Times New Roman","serif";"></span></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kaji perasaan klien tentang citra tubuh dan tingkat harga diri</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Berikan dorongan untuk keikutsertaan kontinyu dalam aktifitas dan pembuatan keputusan</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Berikan dorongan pada klien dan pasangannya untuk saling berbagi kekhawatiran tentang perubahan fungsi seksual dan menggali alternatif untuk ekspresi seksual yang lazim</span></li>
</ul><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Diagnosa 3 : Resiko tinggi terhadap disfungsi seksual b.d perubahan struktur atau fungsi tubuh, perubahan kadar hormon</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Tujuan :</span></b><span style="font-family: "Times New Roman","serif";"> Klien menyatakan paham tentang perubahan struktur dan fungsi seksual.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><span style="font-family: "Times New Roman","serif";">- Mengidentifikasi kepuasan/ praktik seksual yang diterima dan beberapa alternatif cara mengekspresikan keinginan seksual</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%;"><b><span style="font-family: "Times New Roman","serif";">Intervensi:</span></b><span style="font-family: "Times New Roman","serif";"></span></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Mendengarkan pernyataan klien dan pasangan</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Diskusikan sensasi atau ketidaknyamanan fisik, perubahan pada respons individu</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Kaji informasi klien dan pasangan tentang anatomi/ fungsi seksual dan pengaruh prosedur pembedahan</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Identifikasi faktor budaya/nilai budaya</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Bantu klien untuk menyadari atau menerima tahap berduka</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Dorong klien untuk menyadari atau menerima tahap berduka</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Dorong klien untuk berbagi pikiran/masalah dengan orang terdekatnya</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">Berikan solusi masalah terhadap masalah potensial. ex : menunda koitus seksual saat kelelahan</span></li>
</ul><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin-left: 36pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB IV</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div align="center" class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin-left: 36pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">KESIMPULAN & SARAN</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #3d85c6; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Kanker ovarium adalah tumor ganas pada ovarium (indung telur) yang paling sering ditemukan pada wanita berusia 50 – 70 tahun. Kanker ovarium bisa menyebar ke bagian lain, panggul, dan perut melalui sistem getah bening dan melalui sistem pembuluh darah menyebar ke hati dan paru-paru.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #3d85c6; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Waspadai tanda dan gejala Kanker Ovarium :</span></div><div class="MsoListParagraphCxSpLast" style="color: #3d85c6; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Gejala umum bervariasi dan tidak spesifik. Pada stadium awal berupa :<span> </span></span></div><ul style="color: #3d85c6;" type="disc"><li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">haid tidak teratur</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">ketegangan menstrual yang terus meningkat</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">menoragia</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">nyeri tekan pada payudara</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">menopause dini</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">rasa tidak nyaman pada abdomen</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">dispepsia</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">tekanan pada pelvis</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">sering berkemih</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">flatulenes</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">rasa begah setelah makan makanan kecil</span></li>
<li class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif";">lingkar abdomen yang terus meningkat</span></li>
</ul><div align="center" class="MsoListParagraphCxSpLast" style="color: #3d85c6; line-height: 150%; margin-left: 18pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">DAFTAR PUSTAKA</span></b></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm;"><span style="font-family: "Times New Roman","serif";">Augusfarly, (2008). Askep dengan klien ovarium.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">Capenito, LJ.(2001). Buku Saku Keperawatan, Edisi VIII. Penerjemah Monica Ester, SKp. Jakarta : EGC.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">Engram, Barbara. (1999). Rencana Asuhan Keperawatan Medical Bedah, Vol.3. Jakarta : EGC.<br />
Farrer, Helen. (2001). Maternity Care, Edisi II. Jakarta: EGC.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">http://augusfarly.wordpress.com/2008/09/14/asuhan-keperawatan-dengan-klien-ovarium/. Diakses tanggal 08 Desember 2010.<br />
http://fordearest.wetpaint.com/page/kista+ovarium. Diakses tanggal 08 Desember 2010.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">http://medlinux.blogspot.com/2007/09/kistoma ovarii.html. Diakses tanggal 08 Desember 2010.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">http://www.blogdokter.net/2008/05/30/kista-ovarium/. Diakses tanggal 08 Desember 2010.<br />
Ignatividus Donna, Bayne Varner Marihenn (1991). Medical Surgical Nursing : Anurse Process Approch. USA : W.B. Sounders Company.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">Long Barbara. C (1996). Keperawatan Medical Bedah, Edisi II, USA. The CV Mousby Company.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">NANDA 2005, Nursing diagnoses : Definition and classification 2005-2006, NANDA International, Philadelphia.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">Ropper, Nancy. (1996). Prinsip-prinsip Keperawatan. Alih bahasa Andry Hartono Yogyakarta. Yayasan Essentia Medika</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">Wilkinson, J. W 2006, Buku saku diagnosis keperawatan dengan intervensi NIC dan kriteria hasil NOC, Edisi 7, EGC, Jakarta.</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">Wiknjosastro.et.all. (1999). Ilmu kandungan, Edisi II. Jakarta : YBP SP</span></div><div class="MsoNormal" style="color: #3d85c6; line-height: 150%; margin: 6pt 0cm 6pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";">William Helm, C. Ovarian Cysts. 2005 American College of Obstetricians and Gynecologists ( cited 2005 September 16 ). Available at </span><a href="http://emedicine.com/"><span style="font-family: "Times New Roman","serif";">http://emedicine.com</span></a><span style="font-family: "Times New Roman","serif";"></span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-63247438098113643772011-02-28T04:03:00.001-08:002011-02-28T04:03:03.465-08:00Askep Infertilitas<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: center; text-indent: -21.3pt;"><strong><span style="font-size: 20pt; line-height: 150%;">LANDASAN TEORI</span></strong></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -18pt;"><b><span style="font-size: 16pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><strong><span lang="IN" style="font-size: 16pt; line-height: 150%;">DEF</span></strong><strong><span style="font-size: 16pt; line-height: 150%;">I</span></strong><strong><span lang="IN" style="font-size: 16pt; line-height: 150%;">NISI</span></strong><strong><span style="font-size: 16pt; line-height: 150%;"> INFERTILITAS</span></strong><span style="font-size: 16pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 29.45pt;"><span lang="IN">Infertilitas adalah ketidakmampuan sepasang suami istri untuk memiliki keturunan dimana wanita belum mengalami kehamilan setelah bersenggama secara teratur 2-3 x / minggu, tanpa mamakai matoda pencegahan selama 1 tahun</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 29.45pt;"><span><img height="267" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image007.jpg" width="267" /></span></div><div style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-indent: 36pt;">Definisi infertilitas menurut WHO adalah tidak terjadinya kehamilan pada pasangan yang telah berhubungan intim tanpa menggunakan kontrasepsi secara teratur minimal 1-2 tahun. Menurut data demografis dunia, 12,5 % pasangan usia subur mengalami kesulitan mendapatkan anak.</div><div style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-indent: 36pt;">Infertilitas terutama lebih banyak terjadi di kota-kota besar karena gaya hidup yang penuh stres, emosional dan kerja keras serta pola makan yang tidak seimbang. Infertilitas dapat terjadi dari sisi pria, wanita, kedua-duanya, maupun pasangan. Disebut infertilitas pasangan bila terjadi penolakan sperma suami oleh istri sehingga sperma tidak dapat bertemu dengan sel telur. Hal ini biasanya disebabkan oleh ketidaksesuaian antigen/antibodi pasangan tersebut.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span lang="IN">Ada 2 jenis infertilitas :</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Infertilitas primer : bila pasangan tersebut belum pernah mengalami kehamilan sama sekali.</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Infertilitas sekunder : bila pasangan tersebut sudah pernah melahirkan namun setelah itu tidak pernah hamil lagi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -18pt;"><b><span style="font-size: 16pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><strong><span lang="IN" style="font-size: 16pt; line-height: 150%;">ETIOLOGI</span></strong><span style="font-size: 16pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span lang="IN">Infertilitas tidak semata-mata terjadi kelainan pada wanita saja. Hasil penelitian membuktikan bahwa suami menyumbang 25-40% dari angka kejadian infertil, istri 40-55%, keduanya 10%, dan idiopatik 10%. Hal ini dapat menghapus anggapan bahwa infertilitas terjadi murni karena kesalahan dari pihak wanita/istri.</span></div><div class="MsoNormal" style="color: #6aa84f; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 21.3pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Berbagai gangguan yang memicu terjadinya infertilitas antara lain :</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="color: #6aa84f; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 21.3pt;"><b><u><span lang="IN" style="font-family: "Times New Roman","serif";">PADA WANITA</span></u></b><u><span style="font-family: "Times New Roman","serif";"></span></u></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Gangguan organ reproduksi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Infeksi vagina sehingga meningkatkan keasaman vagina yang akan membunuh sperma dan pengkerutan vagina yang akan menghambat transportasi sperma ke vagina</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Kelainan pada serviks akibat defesiensi hormon esterogen yang mengganggu pengeluaran mukus serviks. Apabila mukus sedikit di serviks, perjalanan sperma ke dalam rahim terganggu. Selain itu, bekas operasi pada serviks yang menyisakan jaringan parut juga dapat menutup serviks sehingga sperma tidak dapat masuk ke rahim</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Kelainan pada uterus, misalnya diakibatkan oleh malformasi uterus yang mengganggu pertumbuhan fetus, mioma uteri dan adhesi uterus yang menyebabkan terjadinya gangguan suplai darah untuk perkembangan fetus dan akhirnya terjadi abortus berulang</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Kelainan tuba falopii akibat infeksi yang mengakibatkan adhesi tuba falopii dan terjadi obstruksi sehingga ovum dan sperma tidak dapat bertemu</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Gangguan ovulasi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: 22.35pt;"><span lang="IN">Gangguan ovulasi ini dapat terjadi karena ketidakseimbangan hormonal seperti adanya hambatan pada sekresi hormon FSH dan LH yang memiliki pengaruh besar terhadap ovulasi. Hambatan ini dapatterjadi karena adanya tumor kranial, stress, dan penggunaan obat-obatan yang menyebabkan terjadinya disfungsi hipothalamus dan hipofise. Bila terjadi gangguan sekresi kedua hormon ini, maka folicle mengalami hambatan untuk matang dan berakhir pada gengguan ovulasi.</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Kegagalan implantasi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: 22.35pt;"><span lang="IN">Wanita dengan kadar progesteron yang rendah mengalami kegagalan dalam mempersiapkan endometrium untuk nidasi. Setelah terjadi pembuahan, proses nidasi pada endometrium tidak berlangsung baik. Akiatnya fetus tidak dapat berkembang dan terjadilah abortus.</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Endometriosis </span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Abrasi genetis</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Faktor immunologis</span></div><div class="MsoNormal" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif";">Apabila embrio memiliki antigen yang berbeda dari ibu, maka tubuh ibu memberikan reaksi sebagai respon terhadap benda asing. Reaksi ini dapat menyebabkan abortus spontan pada wanita hamil.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Lingkungan </span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify;"><span lang="IN">Paparan radiasi dalam dosis tinggi, asap rokok, gas ananstesi, zat kimia, dan pestisida dapat menyebabkan toxic pada seluruh bagian tubuh termasuk organ reproduksi yang akan mempengaruhi kesuburan.</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><b><u><span lang="IN">PADA PRIA</span></u></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span lang="IN">Ada beberapa kelainan umum yang dapat menyebabkan infertilitas pada pria yaitu :</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Abnormalitas sperma; morfologi, motilitas</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Abnormalitas ejakulasi; ejakulasi rerograde, hipospadia</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Abnormalitas ereksi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Abnormalitas cairan semen; perubahan pH dan perubahan komposisi kimiawi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Infeksi pada saluran genital yang meninggalkan jaringan parut sehingga terjadi penyempitan pada obstruksi pada saluran genital</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Lingkungan; Radiasi, obat-obatan anti cancer</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -18pt;"><strong><span style="font-family: "Courier New"; font-weight: normal;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></strong><span lang="IN">Abrasi genetik</span><strong><span style="font-weight: normal;"></span></strong></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -18pt;"><strong><span style="font-size: 16pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></strong><strong><span lang="IN" style="font-size: 16pt; line-height: 150%;">MANIFESTASI KLINIS</span></strong><strong><span style="font-size: 16pt; line-height: 150%;"></span></strong></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Wanita</span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="19" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="19" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Terjadi kelainan system endokrin</span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="19" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="19" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Hipomenore dan amenore</span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="19" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="19" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Diikuti dengan perkembangan seks sekunder yang tidak adekuat menunjukkan masalah pada aksis ovarium hipotalamus hipofisis atau aberasi genetik</span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="19" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="19" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Wanita dengan sindrom turner biasanya pendek, memiliki payudara yang tidak berkembang,dan gonatnya abnormal</span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="19" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="19" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Wanita infertil dapat memiliki uterus </span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="19" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="19" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Motilitas tuba dan ujung fimbrienya dapat menurun atau hilang akibat infeksi, adhesi, atau tumor</span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="19" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="19" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Traktus reproduksi internal yang abnormal</span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Pria</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat terpajan benda – benda mutan yang membahayakan reproduksi (panas, radiasi, rokok, narkotik, alkohol, infeksi)</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Status gizi dan nutrisi terutama kekurangan protein dan vitamin tertentu</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat infeksi genitorurinaria</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Hipertiroidisme dan hipotiroid</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Tumor hipofisis atau prolactinoma</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Disfungsi ereksi berat</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Ejakulasi retrograt</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Hypo/epispadia</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Mikropenis</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Andesensus testis (testis masih dalam perut/dalam liat paha</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Gangguan spermatogenesis (kelainan jumla, bentuk dan motilitas sperma)</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Hernia scrotalis (hernia berat sampai ke kantong testis )</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Varikhokel (varises pembuluh balik darah testis)</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 78.55pt; text-align: justify; text-indent: -18pt;"><strong><span style="font-family: Symbol; font-weight: normal;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></strong><span lang="IN">Abnormalitas cairan semen</span><strong><span style="font-weight: normal;"></span></strong></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -18pt;"><strong><span style="font-size: 16pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></strong><strong><span lang="IN" style="font-size: 16pt; line-height: 150%;">PATOFISIOLOGI</span></strong><strong><span style="font-size: 16pt; line-height: 150%;"></span></strong></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="19" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="19" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Wanita</span><b><span style="font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: 21.25pt;"><span lang="IN">Beberapa penyebab dari gangguan infertilitas dari wanita diantaranya gangguan stimulasi hipofisis hipotalamus yang mengakibatkan pembentukan FSH dan LH tidak adekuat sehingga terjadi gangguan dalam pembentukan folikel di ovarium. Penyebab lain yaitu radiasi dan toksik yng mengakibatkan gangguan pada ovulasi. Gangguan bentuk anatomi sistem reproduksi juga penyebab mayor dari infertilitas, diantaranya cidera tuba dan perlekatan tuba sehingga ovum tidak dapat lewat dan tidak terjadi fertilisasi dari ovum dan sperma. Kelainan bentuk uterus menyebabkan hasil konsepsi tidak berkembang normal walapun sebelumnya terjadi fertilisasi. Abnormalitas ovarium, mempengaruhi pembentukan folikel. Abnormalitas servik mempegaruhi proses pemasukan sperma. Faktor lain yang mempengaruhi infertilitas adalah aberasi genetik yang menyebabkan kromosom seks tidak lengkap sehingga organ genitalia tidak berkembang dengan baik.</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: 21.25pt;"><span lang="IN">Beberapa infeksi menyebabkan infertilitas dengan melibatkan reaksi imun sehingga terjadi gangguan interaksi sperma sehingga sperma tidak bisa bertahan, infeksi juga menyebebkan inflamasi berlanjut perlekatan yang pada akhirnya menimbulkan gangguan implantasi zigot yang berujung pada abortus.</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Pria</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: 21.25pt;"><span lang="IN">Abnormalitas androgen dan testosteron diawali dengan disfungsi hipotalamus dan hipofisis yang mengakibatkan kelainan status fungsional testis. Gaya hidup memberikan peran yang besar dalam mempengaruhi infertilitas dinataranya merokok, penggunaan obat-obatan dan zat adiktif yang berdampak pada abnormalitas sperma dan penurunan libido. Konsumsi alkohol mempengaruhi masalah ereksi yang mengakibatkan berkurangnya pancaran sperma. Suhu disekitar areal testis juga mempengaruhi abnormalitas spermatogenesis. Terjadinya ejakulasi retrograt misalnya akibat pembedahan sehingga menyebebkan sperma masuk ke vesika urinaria yang mengakibatkan komposisi sperma terganggu.</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -18pt;"><strong><span style="font-size: 16pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></strong><strong><span lang="IN" style="font-size: 16pt; line-height: 150%;">PENATALAKSANAAN</span></strong><strong><span style="font-size: 16pt; line-height: 150%;"></span></strong></div><div class="MsoNormal" style="color: #6aa84f; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 35.45pt;"><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Wanita </span></u></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></u></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Pengetahuan tentang siklus menstruasi, gejala lendIr serviks puncak dan waktu yang tepat untuk coital</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Pemberian terapi obat, seperti;</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 107.45pt; text-align: justify; text-indent: -18pt;"><span><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Stimulant ovulasi, baik untuk gangguan yang disebabkan oleh supresi hipotalamus, peningkatan kadar prolaktin, pemberian tsh</span>. </div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 107.45pt; text-align: justify; text-indent: -18pt;"><span><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Terapi penggantian hormon </span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 107.45pt; text-align: justify; text-indent: -18pt;"><span><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Glukokortikoid jika terdapat hiperplasi adrenal</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 107.45pt; text-align: justify; text-indent: -18pt;"><span><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Penggunaan antibiotika yang sesuai untuk pencegahan dan penatalaksanaan infeksi dini yang adekuat</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">GIFT ( gemete intrafallopian transfer )</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Laparatomi dan bedah mikro untuk memperbaiki tuba yang rusak secara luas</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Bedah plastic misalnya penyatuan uterus bikonuate,</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Pengangkatan tumor atau fibroid</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Eliminasi vaginitis atau servisitis dengan antibiotika atau kemoterapi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.3pt; text-align: justify; text-indent: -3.85pt;"><br />
</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.3pt; text-align: justify; text-indent: -3.85pt;"><br />
</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.3pt; text-align: justify; text-indent: -3.85pt;"><b><u><span lang="IN">Pria</span></u></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Penekanan produksi sperma untuk mengurangi jumlah antibodi autoimun, diharapkan kualitas sperma meningkat</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Agen antimikroba</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Testosterone Enantat dan Testosteron Spionat untuk stimulasi kejantanan</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">HCG secara i.m memperbaiki hipoganadisme</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">FSH dan HCG untuk menyelesaikan spermatogenesis</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Bromokriptin, digunakan untuk mengobati tumor hipofisis atau hipotalamus </span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Klomifen dapat diberikan untuk mengatasi subfertilitas idiopatik</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Perbaikan varikokel menghasilkan perbaikan kualitas sperma</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Perubahan gaya hidup yang sederhana dan yang terkoreksi. Seperti, perbaikan nutrisi, tidak membiasakan penggunaan celana yang panas dan ketat</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Perhatikan penggunaan lubrikans saat coital, jangan yang mengandung spermatisida</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 71.45pt; text-align: justify; text-indent: -18pt;"><br />
</div><div align="center" class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><strong><span style="font-size: 20pt; line-height: 150%;">ASUHAN KEPERAWATAN PADA KLIEN DENGAN INFERTILITAS</span></strong><span style="font-size: 20pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-indent: -18pt;"><strong><span style="font-size: 16pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></strong><strong><span lang="IN" style="font-size: 16pt; line-height: 150%;">PENGKAJIAN</span></strong><strong><span style="font-weight: normal;"></span></strong></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-indent: -18pt;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Identitas klien</span>. <span lang="IN">Termasuk data etnis, budaya dan agama</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-indent: -18pt;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Riwayat kesehatan</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt;"><b><u><span lang="IN">Wanita</span></u></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Riwayat Kesehatan Dahulu</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat terpajan benda – benda mutan yang membahayakan reproduksi di rumah</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat infeksi genitorurinaria</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Hipertiroidisme dan hipotiroid</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Infeksi bakteri dan virus ex: toksoplasama</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Tumor hipofisis atau prolaktinoma</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat penyakit menular seksual</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat kista</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Riwayat Kesehatan Sekarang</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Endometriosis dan endometrits</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Vaginismus (kejang pada otot vagina)</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Gangguan ovulasi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Abnormalitas tuba falopi, ovarium, uterus, dan servik</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 117pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Autoimun</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Riwayat Kesehatan Keluarga</span>. <span lang="IN">Memiliki riwayat saudara/keluarga dengan aberasi genetik</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Riwayat Obstetri</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.5pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Tidak hamil dan melahirkan selama satu tahun tanpa alat kontrasepsi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.5pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Mengalami aborsi berulang</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.5pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Sudah pernah melahirkan tapi tidak hamil selama satu tahun tanpa alat kontrasepsi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-indent: -13.65pt;"><b><u><span lang="IN">Pria</span></u></b></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-indent: -18pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Riwayat Kesehatan Dahulu</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat terpajan benda – benda mutan yang membahayakan reproduksi (panas, radiasi, rokok, narkotik, alkohol, infeksi)</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Status gizi dan nutrisi terutama kekurangan protein dan vitamin tertentu</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat infeksi genitorurinaria</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Hipertiroidisme dan hipotiroid</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Tumor hipofisis atau prolactinoma</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Trauma, kecelakan sehinga testis rusak</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Konsumsi obat-obatan yang mengganggu spermatogenesis</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Pernah menjalani operasi yang berefek menganggu organ reproduksi contoh : operasi prostat, operasi tumor saluran kemih</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Riwayat vasektomi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-indent: -18pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Riwayat Kesehatan Sekarang</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Disfungsi ereksi berat</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Ejakulasi retrograt</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Hypo/epispadia</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Mikropenis</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Andesensus testis (testis masih dalam perut/dalam liat paha</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Gangguan spermatogenesis (kelainan jumla, bentuk dan motilitas sperma)</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Saluran sperma yang tersumbat</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Hernia scrotalis (hernia berat sampai ke kantong testis )</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Varikhokel (varises pembuluh balik darah testis)</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Abnormalitas cairan semen</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-indent: -18pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Riwayat Kesehatan Keluarga</span>. <span lang="IN">Memiliki riwayat saudara/keluarga dengan aberasi genetik</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-indent: -18pt;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Pemeriksaan Fisik</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt;"><span lang="IN">Terdapat berbagai kelainan pada organ genital, pria atupun wanita.</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-indent: -18pt;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Pemeriksaan penunjang</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Wanita</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.65pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Deteksi Ovulasi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.65pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Analisa hormon</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.65pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Sitologi vagina</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.65pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Uji pasca senggama</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.65pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Biopsy endometrium terjadwal</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.65pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Histerosalpinografi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.65pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Laparoskopi</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.65pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Pemeriksaan pelvis ultrasound</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Pria</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Analisa Semen</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Parameter</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Warna Putih keruh</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Bau Bunga akasia</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">PH 7,2 – 7,8</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Volume 2 – 5 ml</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Viskositas 1,6 – 6,6 centipose</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Jumlah sperma 20 juta / ml</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Sperma motil > 50%</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Bentuk normal > 60%</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Kecepatan gerak sperma 0,18-1,2 detik</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">persentase gerak sperma motil > 60%</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Aglutasi Tidak ada</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Sel – sel Sedikit,tidak ada</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Uji fruktosa 150-650 mg/dl</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Pemeriksaan endokrin</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">USG </span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Biopsi testis </span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Uji penetrasi sperma</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN">Uji hemizona</span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-indent: -18pt;"><b><span style="font-size: 16pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-size: 16pt; line-height: 150%;">DIAGNOSA KEPERAWATAN</span></b> <span> </span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Harga diri rendah berhubungan dengan kehilangan fungsi tubuh terhadap ketidak mampuan untuk mengandung. ( konsepsi )</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Cemas berhubungan dengan kurang pengetahuan dan pelaksanaan prosedur dan pemecahan masalah.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kurang pengetahuan berhubungan dengan kurang informasi tentang anatomi fisiologi seksual dan tehnik coitus.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-indent: -18pt;"><b><span style="font-size: 16pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-size: 16pt; line-height: 150%;">RENCANA INTERVENSI</span></b> <span> </span></div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-indent: -18pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>DX I<br />
Harga diri rendah berhubungan dengan kehilangan fungsi tubuh terhadap ketidak mampuan untuk mengandung. ( konsepsi )<br />
<b>Tujuan</b> :<br />
Menunjukkan ketidak tepatan perubahan dalam konsep diri tanpa menegatifkan harga diri.<br />
<b>Intervensi</b> :</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Identifikasi masalah peran sebagi wanita, istri, ibu, wanita karir dan sebagainya.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Dorong pertanyaan tentang situasi saat ini dan harapan yang akan datang.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Dorong pasien untuk mengekspresikan perasaannya mis : marah, bermusuhan dan berduka.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Berikan penguatan positif untuk meningkatkan / perbaikan dan partisipasi perawatan diri / program pengobatan.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Yakinkan perasaan / masalah pasangan sehubungan dengan aspek seksual dan berikan informasi dan dukungan.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-indent: -18pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>DX II.<br />
Cemas berhubungan dengan kurang pengetahuan dan pelaksanaan prosedur dan pemecahan masalah.<br />
<b>Tujuan</b> :<br />
Dapat melaporkan rentang perasaan yang tepat.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt;"><b>Intervensi</b> :</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Yakinkan informasi pasien tentang diagnosis, dan therapi yang akan datang.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Jelaskan tujuan dan persiapan untuk tes diagnostik.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Berikan lingkungan perhatian , keterbukaan dan penerimaan juga privasi untuk pasien / orang terdekat.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Dorong pertanyaan dan berikan waktu untuk mengekspresikan takut.<br />
</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-indent: -18pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>DX III.<br />
Kurang pengetahuan berhubungan dengan kurang informasi tentang anatomi fisiologi seksual dan tehnik coitus <br />
</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt;"><b>Tujuan</b> :<br />
Dapat menyatakan pemahaman proses penyakit dan pengobatan.<br />
<b>Intervensi</b> :</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kaji proses penyakit dan harapan yang akan datang.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Diskusikan perlunya keseimbangan kesehatan, nutrisi, makan dan pemasukan cairan yang adekuat.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Anjurkan untuk mengurangi kebiasan –kebiasaan yang jelek seperti : merokok, minum-minuman yang beralkohol dan penggunaan obat-obatan.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>HE untuk memilih makanan yang dapat meningkatkan kesuburan.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>HE untuk menghitung masa subur.</div><div class="MsoListParagraph" style="color: #6aa84f; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><strong><span> </span></strong></div><div align="center" class="MsoNormal" style="color: #6aa84f; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 20pt; line-height: 150%;">DAFTAR PUSTAKA</span></b></div><div class="MsoNormal" style="color: #6aa84f; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif";"><a href="http://anggrekidea.blogspot.com/2007/11/infertilitas.html">http://anggrekidea.blogspot.com/2007/11/infertilitas.html</a></span></div><div class="MsoNormal" style="color: #6aa84f; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif";"><a href="http://rsisultanagung.blogspot.com/2008/10/penyebab-infertilitas-pada-perempuan.html">http://rsisultanagung.blogspot.com/2008/10/penyebab-infertilitas-pada-perempuan.html</a></span></div><div class="MsoNormal" style="color: #6aa84f; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif";"><a href="http://www.askep-askeb.cz.cc/2010/03/askep-infertilitas.html">http://www.askep-askeb.cz.cc/2010/03/askep-infertilitas.html</a></span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-69303252304727384692011-02-28T03:49:00.000-08:002011-02-28T03:49:03.429-08:00Askep Kista Ovarium<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%;">BAB I</span></b></div><div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%;">PENDAHULUAN</span></b></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ovarium merupakan tempat yang umum bagi kista, yang dapat merupakan pembesaran sederhana konstituen ovarium normal, folikel graft, atau korpus luteum, atau kista ovarium dapat timbul akibat pertumbuhan abdomen dari epithelium ovarium.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien dapat melaporkan atau tidak melaporkan nyeri abdomen akut atau kronik. Gejal-gejala tentang rupture kista menstimulasi berbagai kedaruratan abdomen akut, seperti apendisitis, atau kehamilan ektopik. Kista yang lebih besar dapat menyebabkan pembengkakan abdomen dan penekanan pada organ-organ abdomen yang berdekatan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan kista ovarium yang besar biasanya adalah melalui tindakan bedah. Jika ukuran lebar kista kurang dari 5 cm, dan tampak terisi oleh cairan atau fisilogis pada pasien muda yang sehat, kontrasepsi oral dapat digunakan untuk menekan aktivitas ovarium dan menghilangkan kista. Sekitar 98 % lesi yang terjadi pada wanita yang berumur 29 tahun dan yang lebih muda adalah jinak. Setelah usia 50 tahun, hanya 50 % yang jinak. Perawatan pascaoperatif setelah pembedahan untuk mengangkat kista ovarium adalah serupa dengan perawatan setelah pembedahan abdomen, dengan satu pengecualian. Penurunan tekanan intraabdomen yang diakibatkan oleh pengangkatan kista yang besar biasanya mengarah pada distensi abdomen yang berat. Komplikasi ini dapat dicegah sampai suatu tingkat dengan memberikan gurita abdomen yang ketat.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dari uraian di atas, maka penulis ingin mengetahui lebih banyak bagaimana asuhan keperawatan yang diberikam pada penderita kistoma ovary</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Umum</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diharapkan mahasiswa mampu memberikan asuhan keperawatan pada klien dengan kista ovari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Khusus</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu melakukan pengkajian pada klien dengan kista ovary</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu menemukan masalah keperawatan pada klien dengan kista ovari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu merencanakan tindakan keperawatan pada klien dengan kista ovari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu melaksanakan tindakan keperawatan pada klien dengan kista ovari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu mengevaluasi tindakan yang sudah dilakukan pada klien dengan kista ovari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%;">BAB II</span></b></div><div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%;">KONSEP MEDIS</span></b></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.1<span> </span>Definisi</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kista ovarium merupakan suatu pengumpulan cairan yang terjadi pada indung telur atau ovarium. Cairan yang terkumpul ini dibungkus oleh semacam selaput yang terbentuk dari lapisan terluar dari ovarium</span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.2<span> </span>Etiologi</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kista ovarium terbentuk oleh bermacam sebab. Penyebab inilah yang nantinya akan menentukan tipe dari kista. Diantara beberapa tipe kista ovarium, tipe folikuler merupakan tipe kista yang paling banyak ditemukan. Kista jenis ini terbentuk oleh karena pertumbuhan folikel ovarium yang tidak terkontrol.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Folikel adalah suatu rongga cairan yang normal terdapat dalam ovarium. Pada keadaan normal, folikel yang berisi sel telur ini akan terbuka saat siklus menstruasi untuk melepaskan sel telur. Namun pada beberapa kasus, folikel ini tidak terbuka sehingga menimbulkan bendungan carian yang nantinya akan menjadi kista.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cairan yang mengisi kista sebagian besar berupa darah yang keluar akibat dari perlukaan yang terjadi pada pembuluh darah kecil ovarium. Pada beberapa kasus, kista dapat pula diisi oleh jaringan abnormal tubuh seperti rambut dan gigi. Kista jenis ini disebut dengan Kista Dermoid</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.3<span> </span>Patofisiologi</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi ovarium yang normal tergantung kepada sejumlah hormone dan kegagalan pembentukan salah satu hormone tersebut bisa mempengaruhi fungsi ovarium. Ovarium tidak akan berfungsi secara normal jika tubuh wanita tidak menghasilkan <em>hormone hipofisa</em> dalam jumlah yang tepat. Fungsi ovarium yang abnormal kadang menyebabkan penimbunan folikel yang terbentuk secara tidak sempurna di dalam ovarium. Folikel tersebut gagal mengalami pematangan dan gagal melepaskan sel telur, terbentuk secara tidak sempurna di dalam ovarium karena itu terbentuk kista di dalam ovarium. Setiap hari, ovarium normal akan membentuk beberapa kista kecil yang disebut <em>Folikel de Graff</em>. Pada pertengahan siklus, folikel dominan dengan diameter lebih dari 2.8 cm akan melepaskan oosit mature. Folikel yang rupture akan menjadi korpus luteum, yang pada saat matang memiliki struktur 1,5 – 2 cm dengan kista ditengah-tengah. Bila tidak terjadi fertilisasi pada oosit, korpus luteum akan mengalami fibrosis dan pengerutan secara progresif. Namun bila terjadi fertilisasi, korpus luteum mula-mula akan membesar kemudian secara gradual akan mengecil selama kehamilan. Kista ovari yang berasal dari proses ovulasi normal disebut kista fungsional dan selalu jinak.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kista dapat berupa kista folikular dan luteal yang kadang-kadang disebut kista theca-lutein. Kista tersebut dapat distimulasi oleh <em>gonadotropin</em>, termasuk FSH dan HCG. Kista fungsional multiple dapat terbentuk karena stimulasi gonadotropin atau sensitivitas terhadap gonadotropin yang berlebih. Kista folikel dan luteal, kelainan yang tidak berbahaya ini berasal dari folikel graaf yang tidak pecah atau folikel yang sudah pecah dan segera menutup kembali. Kista demikian seringnya adalah multipel dan timbul langsung di bawah lapisan serosa yang menutupi ovarium, biasanya kecil, dengan diameter 1- 1,5 cm dan berisi cairan serosa yang bening, tetapi ada kalanya penimbunan cairan cukup banyak, sampai mencapai diameter 4-5 cm, sehingga teraba massa dan menimbulkan sakit pada daerah pelvis.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.4<span> </span>Tipe Kista </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.4.1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tipe Kista Normal</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kista Fungsional </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ini merupakan jenis kista ovarium yang paling banyak ditemukan. Kista ini berasal dari sel telur dan korpus luteum, terjadi bersamaan dengan siklus menstruasi yang normal. Kista fungsional akan tumbuh setiap bulan dan akan pecah pada masa subur, untuk melepaskan sel telur yang pada waktunya siap dibuahi oleh sperma. Setelah pecah, kista fungsional akan menjadi kista folikuler dan akan hilang saat menstruasi. Kista fungsional terdiri dari: kista folikel dan kista korpus luteum. Keduanya tidak mengganggu, tidak menimbulkan gejala dan dapat menghilang sendiri dalam waktu 6-8 minggu</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.4.2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tipe Kista Abnormal</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cystadenoma, </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merupakan kista yang berasal dari bagian luar sel indung telur. Biasanya bersifat jinak, namun dapat membesar dan dapat menimbulkan nyeri.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kista coklat (endometrioma), Merupakan endometrium yang tidak pada tempatnya. Disebut kista coklat karena berisi timbunan darah yang berwarna coklat kehitaman.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kista dermoid</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merupakan kista yang yang berisi berbagai jenis bagian tubuh seperti kulit, kuku, rambut, gigi dan lemak. Kista ini dapat ditemukan di kedua bagian indung telur. Biasanya berukuran kecil dan tidak menimbulkan gejala.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kista endometriosis, Merupakan kista yang terjadi karena ada bagian endometrium yang berada di luar rahim. Kista ini berkembang bersamaan dengan tumbuhnya lapisan endometrium setiap bulan sehingga menimbulkan nyeri hebat, terutama saat menstruasi dan infertilitas.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kista hemorrhage, Merupakan kista fungsional yang disertai perdarahan sehingga menimbulkan nyeri di salah satu sisi perut bagian bawah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kista lutein, Merupakan kista yang sering terjadi saat kehamilan. Beberapa tipe kista lutein antara lain:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 144pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1).<span> </span>Kista granulosa lutein, Merupakan kista yang terjadi di dalam korpus luteum ovarium yang fungsional. Kista yang timbul pada permulaan kehamilan ini dapat membesar akibat dari penimbunan darah yang berlebihan saat menstruasi dan bukan akibat dari tumor. Diameternya yang mencapai 5-6 cm menyebabkan rasa tidak enak di daerah panggul. Jika pecah, akan terjadi perdarahan di rongga perut</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 144pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2).<span> </span>Kista theca lutein, Merupakan kista yang berisi cairan bening dan berwarna seperti jerami. Timbulnya kista ini berkaitan dengan tumor ovarium dan terapi hormon</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kista polikistik ovarium, Merupakan kista yang terjadi karena kista tidak dapat pecah dan melepaskan sel telur secara kontinyu. Biasanya terjadi setiap bulan. Ovarium akan membesar karena bertumpuknya kista ini. Untuk kista polikistik ovarium yang menetap (persisten), operasi harus dilakukan untuk mengangkat kista tersebut agar tidak menimbulkan gangguan dan rasa sakit.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.5<span> </span>Manifestasi Klinis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Manifestasi klinis kista ovarium antara lain:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sering tanpa gejala.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri saat menstruasi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri di perut bagian bawah.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri pada saat berhubungan badan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri pada punggung terkadang menjalar sampai ke kaki.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terkadang disertai nyeri saat buang air kecil dan/atau buang air besar.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Siklus menstruasi tidak teratur; bisa juga jumlah darah yang keluar banyak</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.6<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insiden</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada sebagian besar kanker ovarium berbentuk tumor kistik (kista ovarium) dan sebagian kecil berbentuk tumor padat. Kanker ovarium merupakan penyebab kematian terbanyak dari semua kanker ginekologi. Angka kematian yang tinggi ini disebabkan karena penyakit ini awalnya bersifat asimptomatik dan baru menimbulkan keluhan apabila sudah berada dalam stadium akhir. Kista dermoid yang merupakan bagian dari kista ovarium 80 % didapati pada penderita yang berusia antara 20-30 tahun. Pada wanita usia muda (biasanya kurang dari 40 tahun) resiko tumor menjadi ganas berkurang, oleh karena itu kista dapat dikontrol dengan USG pelvic. Ada beberapa yang menjadi ganas, dengan risiko terjadinya karsinoma terutama pada wanita wanita yang mulai <em>menopause. </em>Pada usia rata-rata 30 tahun, tumor rata-rata berukuran 6 cm dan teratoma bilateral kira-kira 10 %. Sebagian besar wanita dengan teratoma matur bersifat asimptomatik. Pada kista dermoid yang simptomatik,sebagian besar timbul nyeri perut dan perasan yang tidak menyenangkan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.7<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda dan Gejala</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kebayakan tumor ovarium tidak menunjukan tanda dan gejala. Sebagian besar gejala yang ditemukan adalah akibat pertumbuhan aktivitas hormone atau komplikasi tumor tersebut. </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda dan gejala yang sering muncul pada kista ovarium antara lain :</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menstruasi yang tidak teratur, disertai nyeri</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">perasaan penuh dan dtertekan diperut bagian bawah</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">nyeri saat bersenggama</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">perdarahan</span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.8<span> </span>Pemeriksaan Diagnostik</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keterlambatan mendiagnosis kanker ovarium sering terjadi karena letak ovarium berada didalam rongga panggul sehingga tidak terlihat dari luar. Biasanya kanker ovarium ini di deteksi lewat pemeriksaan dalam. Bila kistanya sudah membesar maka akan terabab ada benjolan. Jika dokter menemukan kista, maka selanjutanya akan dilakukan USG untuk memastikan apakah ada tanda tanda kanker atau tidak</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemudian dibutuhkan pemeriksaan lanjutan dengan mengambil jaringan (biopsy) untuk memastikan kista tersebut jinak atau ganas. Ini bisa dilakukan dengan laparskopi, melalui lubang kecil di perut. Pemeriksaan lainnya dengan CT Scan dan tumor marker dengan pemeriksaan darah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.9<span> </span>Penatalaksanan</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengangkatan kista ovarium yang besar biasanya adalah melalui tindakan bedah, misal laparatomi, kistektomi atau laparatomi salpingooforektomi.</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kontrasepsi oral dapat digunakan untuk menekan aktivitas ovarium dan menghilangkan kista.</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perawatan pasca operasi setelah pembedahan untuk mengangkat kista ovarium adalah serupa dengan perawatan setelah pembedahan abdomen dengan satu pengecualian penurunan tekanan intra abdomen yang diakibatkan oleh pengangkatan kista yang besar biasanya mengarah pada distensi abdomen yang berat. Hal ini dapat dicegah dengan memberikan gurita abdomen sebagai penyangga.</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tindakan keperawatan berikut pada pendidikan kepada klien tentang pilihan pengobatan dan manajemen nyeri dengan analgetik / tindakan kenyamanan seperti kompres hangat pada abdomen atau teknik relaksasi napas dalam, informasikan tentang perubahan yang akan terjadi seperti tanda – tanda infeksi, perawatan insisi luka operasi. ( Lowdermilk.dkk. 2005:273</span></div><div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%;">BAB III</span></b></div><div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%;">KONSEP KEPERAWATAN</span></b></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.1<span> </span>Pengkajian</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian umum kista:</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada tidaknya keluhan nyeri diperut bagian bawah?</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada tidaknya gangguan BAB dan BA?</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada tidaknya asites?</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada tidaknya perut membuncit?</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada tidaknya gangguan nafsu makan?</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada tidaknya kembung?</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada tidaknya sesak nafas?</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian diagnostic kista:</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">USG : Ada tidaknya benjolan berdiameter > 5 cm</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">CT Scan: Ada tidaknya benjolan dan ukuran benjolan.</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman ( Nyeri ) berhubungan dengan putaran tangkai tumor/ infeksi pada tumor.</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman ( cemas ) berhubungan dengan kurangnya pengetahuan tentang penyakit dan penatalaksanaannya.</span></div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan harga diri berhubungan dengan perubahan feminimitas dan efek hubungan seksual</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko infeksi daerah operasi berhubungan dengan perawatan luka operasi yg kurang adequat.</span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana Tindakan</span></div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman ( Nyeri ) berhubungan dengan putaran tangkai tumor/ infeksi pada tumor (Tujuan: Setelah diberi tindakan keperawatan nyeri berkurang sampai hilang sama sekali)</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji tingkat dan intensitas nyeri.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ mengidentifikasi lingkup masalah)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Atur posisi senyaman mungkin.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ Menurunkan tingkat ketegangan pada daerah nyeri)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolabarasi untuk pemberian terapi analgesik.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/menghilangkan rasa nyeri)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ajarkan dan lakukan tehnik relaksasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(Merelaksasi otot – otot tubuh).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman ( cemas ) berhubungan dengan kurangnya pengetahuan tentang penyakit dan penatalaksanaannya. (Tujuan : Setelah 1 X 24 Jam diberi tindakan, gangguan rasa nyaman (cemas) berkurang.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji dan pantau terus tingkat kecemasan klien. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ mengidentifikasi lingkup masalah secara dini, sebagai pedoman tindakan selanjutnya )</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan kesempatan tentang apa yang dia rasakan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ memberikan minat dan memperbaiki kesalahan konsep)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan penjelasan tentang semua permasalahan yang berkaitan dengan penyakitnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ Informasi yang tepat menambah wawasan klien sehingga klien tahu tentang keadaan dirinya )</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bina hubungan yang terapeutik dengan klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ Hubungan yang terapeutuk dapat menurunkan tingkat kecemasan klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan harga diri berhubungan dengan perubahan feminimitas dan efek hubungan seksual</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(Tujuan : setelah dilakukan tindakan keperwatan menyatakan penerimaan diri pada situasi dan adaptasi perubhan pada citra tubuh.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji stress emosi klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ untuk melakukan tindakan selanjutnya)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan kesempatan klien untuk mengungkapkan perasaannya terhadap perubahan status kesehatannya</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ Memberikan minat dan perhatian serta memperbaiki kesalahan konsep)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan informasi yang akurat</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ memberikan kesempatan pada pasien untuk bertanya dan mengasimilasi informasi)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan dukungan spiritual kepada klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ agar klien tetap bersemangat dan tidak berputus asa terhadap perubahan status kesehatannya)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko infeksi daerah operasi berhubungan dengan perawatan luka</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">operasi yg kurang adequat.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(Tujuan : Selama dalam perawatan, infeksi luka operasi tidak terjadi)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau dan observasi terus tentang keadaan luka operasinya.<br />
(R/ Deteksi dini tentang terjadinya infeksi yang lebih berat )</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan perawatan luka operasi secara aseptik dan antiseptik.<br />
(R. menekan sekecil mungkin sumber penularan eksterna )</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam pemberian antibiotika.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(R/ Membunuh mikro organisme secara rasional )</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.4<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil yang diharapkan :</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Melaporkan nyeri hilang/terkontrol dan menunjukkan postur rileks</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tampak rileks dan melaporkan ansietas berkurang dan mengungkapkan keakuratan pengetahuan tentang situasi</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencapai masa penyembuhan tepat waktu, tanpa bukti penyebaran infeksi endogen</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien menerima terhadap perubahan/ citra tubuh terhadap diriny</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DAFTAR PUSTAKA</span></b></div><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Doenges, Marilyn E, dkk.(1999).<em>Rencana Asuhan Keperawatan : Pedoman untuk Perencanaan dan Pendokumentasian Perawatan Pasien</em>. Alih Bahasa, I Made Kariasa, N Made Sumarwati. Editor edisi bahasa Indonesia, Monica Ester, Yasmin asih. Ed.3. Jakarta : EGC</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lowdermilk, perta. 2005. <i>Maternity Women’s Health Care. Seventh edition.</i> Philadelphia : Mosby.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><cite><span style="font-size: 12pt; line-height: 150%;">netsains.com/2009/08/tips-praktis-mengatasi-<b>kista</b>-<b>ovarium</b></span></cite><b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></i></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sjamjuhidayat & Wim de Jong. 2005. <i>Buku Ajar Ilmu Bedah. Edisi 2.</i> Jakarta : EGC</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><cite><span style="font-size: 12pt; line-height: 150%;">trilestari.staff.umm.ac.id/files/2010/01/<b>KISTA</b>-<b>OVARIUM</b>.ppt</span></cite></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-50461620262220633512011-02-22T17:45:00.000-08:002011-02-22T17:45:00.492-08:00Askep Hidrosefalus<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">PENDAHULUAN</span></b></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hidrosefalus berasal dari kata <i>hidro</i> yangberarti <u>air</u> dan <i>chepalon</i> yang berarti <u>kepala.</u> Hidrosefalus merupakan penumpukan cairan serebrospinal secara aktif yang menyebabkan dilatasi system ventrikel otak dimana terjadi akumulasi cairan yang berlebihan pada satru atau lebih ventrikel atau ruang subarachnoid.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kita mengenal “Hydrocephalus” sebagai suatu kelainan yang biasanya terjadi pada bayi, dan ditandai dengan membesarnya kepala melebihi ukuran normal. Namun apa sebenarnya hydrocephalus dan bagaimana penanganannya ? </span></div><div style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: 10pt; line-height: 150%;">Dalam keadaan normal, tubuh memproduksi cairan otak (Cairan Serebro Spinal = CSS) dalam jumlah tertentu, untuk kemudian didistribusikan dalam ruang-ruang ventrikel otak, sampai akhirnya diserap kembali. Dalam keadaan dimana terdapat ketidakseimbangan antara produksi dan penyerapan kembali, terjadi penumpukan cairan otak di ventrikel. Kondisi inilah yang dalam istilah medis dikenal sebagai “hydrocephalus”.</span></div><div style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: 10pt; line-height: 150%;">Meskipun banyak ditemukan pada bayi dan anak, sebenarnya hydrocephalus juga bisa terjadi pada dewasa. Hanya saja, pada bayi gejala klinisnya tampak lebih jelas, sehingga lebih mudah dideteksi dan didiagnosis. Hal ini dikarenakan pada bayi ubun-ubunnya masih terbuka, sehingga adanya penumpukan cairan otak dapat dikompensasi dengan melebarnya tulang-tulang tengkorak. Terlihat pembesaran diameter kepala yang makin lama makin membesar seiring bertambahnya tumpukan CSS. Sedangkan pada orang dewasa, tulang tengkorak tidak lagi mampu melebar. Akibatnya berapapun banyaknya CSS yang tertumpuk, takkan mampu menambah besar diameter kepala.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">HIDROSEFALUS</span></b></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Definisi</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hidrosefalus adalah kelainan patologis otak yang mengakibatkan bertambahnya cairan serebrospinal dengan atau pernah dengan tekanan intrakranial yang meninggi, sehingga terdapat pelebaran ventrikel (<b>Darsono, 2005:209</b>). Pelebaran ventrikuler ini akibat ketidakseimbangan antara produksi dan absorbsi cairan serebrospinal. </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hidrosefalus selalu bersifat sekunder, sebagai akibat penyakit atau kerusakan otak. Adanya kelainan-kelainan tersebut menyebabkan kepala menjadi besar serta terjadi pelebaran sutura-sutura dan ubun-ubun (<b>DeVito EE et al, 2007:328).</b></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Bayi prematur rawan terkena hidrosefalus atau mengalami timbunan cairan di dalam rongga otak. Pasalnya otak bayi prematur belum berkembang secara memadai. Selain pada bayi, hidrosefalus juga dapat terjadi pada usia anak. </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">"Dalam hal ini, pembuluh darah yang ada di dinding rongga otak masih lemah dan rapuh, sehingga mudah pecah yang menyebabkan perdarahan masuk ke rongga otak dan dapat menyumbat lintasan cairan otak yang bersifat sementara atau permanen.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Menurut , Kepala Unit Pelayanan Fungsional/Staf Medik Fungsional (SMF) Bedah Saraf Rumah Sakit Dr Sardjito Yogyakarta, Dr P Sudiharto mengemukakan hal itu belum lama ini.<span> </span>hidrosefalus dapat terjadi jika produksi cairan otak lebih besar daripada absorpsinya atau jika lintasan drenase tersumbat. Jika terjadi sumbatan, cairan tertimbun dalam rongga otak sehingga menekan jaringan otak di sekitarnya. </span></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: center; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><img alt="12724.jpg" height="207" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image007.jpg" width="366" /></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: center; text-indent: 36pt;"><br />
</div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Etiologi</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hidrosefalus terjadi bila terdapat penyumbatan aliran cairan serebrospinal (CSS) pada salah satu tempat antara tempat pembentukan CSS dalam sistem ventrikel dan tempat absorbsi dalam ruang subaraknoid. Akibat penyumbatan, terjadi dilatasi ruangan CSS diatasnya (Allan H. Ropper, 2005). </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Teoritis pembentukan CSS yang terlalu banyak dengan kecepatan absorbsi yang abnormal akan menyebabkan terjadinya hidrosefalus, namun dalam klinik sangat jarang terjadi. Penyebab penyumbatan aliran CSS yang sering terdapat pada bayi dan anak ialah:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kelainan Bawaan (Kongenital)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Stenosis akuaduktus Sylvii</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Spina bifida dan kranium bifida</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Sindrom Dandy-Walker</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kista araknoid dan anomali pembuluh darah</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Infeksi</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.15pt; text-align: justify; text-indent: -3.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Akibat infeksi dapat timbul perlekatan meningen. Secara patologis terlihat penebalan jaringan piamater dan araknoid sekitar sisterna basalis dan daerah lain. Penyebab lain infeksi adalah toxoplasmosis.</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Neoplasma</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hidrosefalus oleh obstruksi mekanik yang dapat terjadi di setiap tempat aliran CSS. Pada anak yang terbanyak menyebabkan penyumbatan ventrikel IV atau akuaduktus Sylvii bagian terakhir biasanya suatu glioma yang berasal dari serebelum, penyumbatan bagian depan ventrikel III disebabkan kraniofaringioma.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Perdarahan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Perdarahan sebelum dan sesudah lahir dalam otak, dapat menyebabkan fibrosis leptomeningen terutama pada daerah basal otak, selain penyumbatan yang terjadi akibat organisasi dari darah itu sendiri (Allan H. Ropper, 2005:360).</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Patofisiologi</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">CSS yang dibentuk dalam sistem ventrikel oleh pleksus khoroidalis kembali ke dalam peredaran darah melalui kapiler dalam piamater dan arakhnoid yang meliputi seluruh susunan saraf pusat (SSP). Cairan likuor serebrospinalis terdapat dalam suatu sistem, yakni sistem internal dan sistem eksternal. Pada orang dewasa normal jumlah CSS 90-150 ml, anak umur 8-10 tahun 100-140 ml, bayi 40-60 ml, neonatus 20-30 ml dan prematur kecil 10-20 ml. Cairan yang tertimbun dalam ventrikel 500-1500 ml (Darsono, 2005). Aliran CSS normal ialah dari ventrikel lateralis melalui foramen monroe ke ventrikel III, dari tempat ini melalui saluran yang sempit akuaduktus Sylvii ke ventrikel IV dan melalui foramen Luschka dan Magendie ke dalam ruang subarakhnoid melalui sisterna magna. Penutupan sisterna basalis menyebabkan gangguan kecepatan resorbsi CSS oleh sistem kapiler. (DeVito EE et al, 2007:32) </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><img alt="I10-80-ventricles.jpg" height="249" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image009.jpg" width="498" /></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Hidrosefalus secara teoritis terjadi sebagai akibat dari tiga mekanisme yaitu :</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Produksi likuor yang berlebihan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Peningkatan resistensi aliran likuor</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Peningkatan tekanan sinus venosa</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.8pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Konsekuensi tiga mekanisme di atas adalah peningkatan tekanan intrakranial sebagai upaya mempertahankan keseimbangan sekresi dan absorbsi. Mekanisme terjadinya dilatasi ventrikel cukup rumit dan berlangsung berbeda-beda tiap saat selama perkembangan hidrosefalus. </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.8pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Dilatasi ini terjadi sebagai akibat dari :</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kompresi sistem serebrovaskuler.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Redistribusi dari likuor serebrospinalis atau cairan ekstraseluler</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Perubahan mekanis dari otak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Efek tekanan denyut likuor serebrospinalis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hilangnya jaringan otak.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 39.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pembesaran volume tengkorak karena regangan abnormal sutura kranial.</span></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><img alt="human_brain_ventricular_system.jpg" height="218" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image011.jpg" width="413" /></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.8pt; text-align: justify; text-indent: 21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Produksi likuor yang berlebihan disebabkan tumor pleksus khoroid. Gangguan aliran likuor merupakan awal dari kebanyakan kasus hidrosefalus. Peningkatan resistensi yang disebabkan gangguan aliran akan meningkatkan tekanan likuor secara proporsional dalam upaya mempertahankan resorbsi yang seimbang.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.8pt; text-align: justify; text-indent: 21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Peningkatan tekanan sinus vena mempunyai dua konsekuensi, yaitu peningkatan tekanan vena kortikal sehingga menyebabkan volume vaskuler intrakranial bertambah dan peningkatan tekanan intrakranial sampai batas yang dibutuhkan untuk mempertahankan aliran likuor terhadap tekanan sinus vena yang relatif tinggi. Konsekuensi klinis dari hipertensi vena ini tergantung dari komplians tengkorak. (Darsono, 2005:212)</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Klasifikasi</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Klasifikasi hidrosefalus bergantung pada faktor yang berkaitan dengannya, berdasarkan :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Gambaran klinis, dikenal hidrosefalus manifes (overt hydrocephalus) dan hidrosefalus tersembunyi (occult hydrocephalus).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Waktu pembentukan, dikenal hidrosefalus kongenital dan hidrosefalus akuisita.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Proses terbentuknya, dikenal hidrosefalus akut dan hidrosefalus kronik.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Sirkulasi CSS, dikenal hidrosefalus komunikans dan hidrosefalus non komunikans.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hidrosefalus interna menunjukkan adanya dilatasi ventrikel, hidrosefalus eksternal menunjukkan adanya pelebaran rongga subarakhnoid di atas permukaan korteks. Hidrosefalus obstruktif menjabarkan kasus yang mengalami obstruksi pada aliran likuor. Berdasarkan gejala, dibagi menjadi hidrosefalus simptomatik dan asimptomatik. Hidrosefalus arrested menunjukan keadaan dimana faktor-faktor yang menyebabkan dilatasi ventrikel pada saat tersebut sudah tidak aktif lagi. Hidrosefalus ex-vacuo adalah sebutan bagi kasus ventrikulomegali yang diakibatkan atrofi otak primer, yang biasanya terdapat pada orang tua. (Darsono, 2005)</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Manifestasi Klinik</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tanda awal dan gejala hidrosefalus tergantung pada awitan dan derajat ketidakseimbangan kapasitas produksi dan resorbsi CSS (Darsono, 2005). Gejala-gejala yang menonjol merupakan refleksi adanya hipertensi intrakranial. Manifestasi klinis dari hidrosefalus pada anak dikelompokkan menjadi dua golongan, yaitu :</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Awitan hidrosefalus terjadi pada masa neonatus</span><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Meliputi pembesaran kepala abnormal, gambaran tetap hidrosefalus kongenital dan pada masa bayi. Lingkaran kepala neonatus biasanya adalah 35-40 cm, dan pertumbuhan ukuran lingkar kepala terbesar adalah selama tahun pertama kehidupan. Kranium terdistensi dalam semua arah, tetapi terutama pada daerah frontal. Tampak dorsum nasi lebih besar dari biasa. Fontanella terbuka dan tegang, sutura masih terbuka bebas. Tulang-tulang kepala menjadi sangat tipis. Vena-vena di sisi samping kepala tampak melebar dan berkelok. (Peter Paul Rickham, 2003)</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Awitan hidrosefalus terjadi pada akhir masa kanak-kanak</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pembesaran kepala tidak bermakna, tetapi nyeri kepala sebagai manifestasi hipertensi intrakranial. Lokasi nyeri kepala tidak khas. Dapat disertai keluhan penglihatan ganda (diplopia) dan jarang diikuti penurunan visus. Secara umum gejala yang paling umum terjadi pada pasien-pasien hidrosefalus di bawah usia dua tahun adalah pembesaran abnormal yang progresif dari ukuran kepala. Makrokrania mengesankan sebagai salah satu tanda bila ukuran lingkar kepala lebih besar dari dua deviasi standar di atas ukuran normal. Makrokrania biasanya disertai empat gejala hipertensi intrakranial lainnya yaitu:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Fontanel anterior yang sangat tegang.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Sutura kranium tampak atau teraba melebar.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kulit kepala licin mengkilap dan tampak vena-vena superfisial menonjol.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Gejala hipertensi intrakranial lebih menonjol pada anak yang lebih besar dibandingkan dengan bayi. Gejalanya mencakup: nyeri kepala, muntah, gangguan kesadaran, gangguan okulomotor, dan pada kasus yang telah lanjut ada gejala gangguan batang otak akibat herniasi tonsiler (bradikardia, aritmia respirasi). (Darsono, 2005:213).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pemeriksaan </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pemeriksaan fisik: </span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pengukuran lingkaran kepala secara berkala. Pengukuran ini penting untuk melihat pembesaran kepala yang progresif atau lebih dari normal</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Transiluminasi</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pemeriksaan darah:</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tidak ada pemeriksaan darah khusus untuk hidrosefalus</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pemeriksaan cairan serebrospinal:</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Analisa cairan serebrospinal pada hidrosefalus akibat perdarahan atau meningitis untuk mengetahui kadar protein dan menyingkirkan kemungkinan ada infeksi sisa</span><a href="" name="section~workup"></a><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pemeriksaan radiologi:</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">X-foto kepala: tampak kranium yang membesar atau sutura yang melebar.</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">USG kepala: dilakukan bila ubun-ubun besar belum menutup.</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">CT Scan kepala: untuk mengetahui adanya pelebaran ventrikel dan sekaligus mengevaluasi struktur-struktur intraserebral lainnya</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Diagnosis</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Disamping dari pemeriksaan fisik, gambaran klinik yang samar-samar maupun yang khas, kepastian diagnosis hidrosefalus dapat ditegakkan dengan menggunakan alat-alat radiologik yang canggih. </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pada neonatus, USG cukup bermanfaat untuk anak yang lebih besar, umumnya diperlukan CT scanning. </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">CT scan dan MRI dapat memastikan diagnosis hidrosefalus dalam waktu yang relatif singkat. CT scan merupakan cara yang aman dan dapat diandalkan untuk membedakan hidrosefalus dari penyakit lain yang juga menyebabkan pembesaran kepala abnormal, serta untuk identifikasi tempat obstruksi aliran CSS. (Darsono, 2005:214)</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Diagnosis Banding</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pembesaran kepala dapat terjadi pada hidrosefalus, makrosefali, tumor otak, abses otak, granuloma intrakranial, dan hematoma subdural perinatal, hidranensefali. Hal-hal tersebut dijumpai terutama pada bayi dan anak-anak berumur kurang dari 6 tahun. (Darsono, 2005:215)</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 21.8pt;"><br />
</div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Terapi</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 14.2pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Pada dasarnya ada tiga prinsip dalam pengobatan hidrosefalus, yaitu : </span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Mengurangi produksi CSS.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Mempengaruhi hubungan antara tempat produksi CSS dengan tempat absorbsi.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pengeluaran likuor (CSS) kedalam organ ekstrakranial. (Darsono, 2005)</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 14.2pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Penanganan hidrosefalus juga dapat dibagi menjadi :</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Penanganan Sementara</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 32.2pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Terapi konservatif medikamentosa ditujukan untuk membatasi evolusi hidrosefalus melalui upaya mengurangi sekresi cairan dari pleksus khoroid atau upaya meningkatkan resorbsinya.</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Penanganan Alternatif (Selain Shunting)</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Misalnya : pengontrolan kasus yang mengalami intoksikasi vitamin A, reseksi radikal lesi massa yang mengganggu aliran likuor atau perbaikan suatu malformasi. Saat ini cara terbaik untuk melakukan perforasi dasar ventrikel III adalah dengan teknik bedah endoskopik. (Peter Paul Rickham, 2003)</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Operasi Pemasangan ‘Pintas’ (Shunting)</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Operasi pintas bertujuan membuat saluran baru antara aliran likuor dengan kavitas drainase. Pada anak-anak lokasi drainase yang terpilih adalah rongga peritoneum. Biasanya cairan serebrospinalis didrainase dari ventrikel, namun kadang pada hidrosefalus komunikans ada yang didrain ke rongga subarakhnoid lumbar. Ada dua hal yang perlu diperhatikan pada periode pasca operasi, yaitu: pemeliharaan luka kulit terhadap kontaminasi infeksi dan pemantauan kelancaran dan fungsi alat shunt yang dipasang. Infeksi pada shunt meningatkan resiko akan kerusakan intelektual, lokulasi ventrikel dan bahkan kematian. (Allan H. Ropper, 2005:360)</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>J.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Penatalaksanaan</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Farmakologis:</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Mengurangi volume cairan serebrospinalis:</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Acetazolamide</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> 25 mg/KgBB/hari PO dibagi dalam 3 dosis. Dosis dapat dinaikkan 25 mg/KgBB/hari (Maksimal 100 mg/KgBB/hari)</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Furosemide</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> 1 mg/KgBB/hari PO dibagi dalam 3-4 dosis</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Catatan: <i>Lakukan pemeriksaan serum elektrolit secara berkala untuk mencegah terjadinya efek samping</i>.</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Bila ada tanda-tanda infeksi, beri antibiotika sesuai kuman penyebab.</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Penatalaksanaan Medis</span></i></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pada sebagian pasien pembesaran kepala berhenti sendiri (arrested hyrdosefalus), mungkin oleh rekanalisasi ruang subaraknoid atau kompensasi pembentukan CSS yang berkurang ( Laurence, 1965). Tindakan bedah belum ada yang memuaskan 100 %, kecuali bila penyebabnya ialah tumor yang masih dapat diangkat.</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Penatalaksanaan Keperawatan</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Perawatan Prabedah :</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pantau, cegah, dan halangi bila ada peningkatan TIK</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Letakkan anak dalam posisi nyaman dengan cara menaikkan kepala tempat tidur setinggi 30 derajat ( untuk mengurangi kongesti dan meningkatkan drainase).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pantau adanya tanda – tanda peningktan TIK.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Peningkatan frekwensi pernapasan, penurunan denyut apeks, peningkatan</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.5pt; text-align: justify; text-indent: 4.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">tekanan darah dan peningkatan suhu badan.</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Penurunan tingkat kesadaran.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Aktivitas kejang.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>e)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Perubahan ukuran, kesimetrisan, dan reaktivitas pupil.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>f)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Fontanel “penuh”, cenderung menonjol.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>g)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Turunkan stimulus luar.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>h)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Siapkan oksigen dan alat penghisap di sisi tempat tidur.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Siapkan anak dan orang tua untuk menghadapi prosedur pembedahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan penjelasan yang sesuai dengan usia.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan dan kuatkan keterangan yang diberikan pada orang tua tentang kondisi dan pengobatan anak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Perawatan Pascabedah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pantau tanda – tanda vital dan status neurologik anak ; Laporkan adanya peningkatan TIK ( ukuran, penuhnya, ketegangan fontanel anterior ), penurunan tingkat kesadaran, anoreksia, muntah, konvulasi, kejang, atau kelembaman.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pantau dan laporkan adanya gejala – gejala infeksi ( demam, nyeri tekan, inflamasi, mual, dan muntah ).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pantau dan pertahankan fungsi pirau.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Laporkan gejala malformasi pirau (iritabilitas, penurunan <span> </span>kesadaran, muntah).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Periksa pirau untuk kepenuhan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Naikkan bagian kepala tempat tidur setinggi 30 dertajat (untuk meningkatkan drainase dan menurunkan kongeti vena).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Posisikan anak miring kekiri (sisi non - bedah).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>e)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pertahankan tirah baring selama 24 sampai 72 jam.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>f)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pantau adanya aktivitas serangan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Bantu anak dan orang tua dalam mengatasi stress emosional karena hospitalisais dan pembedahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan informasi yang sesuai dengan usia sebelum prosedur dilakukan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Dorong partisipasi dalam kegiatan rekreasi dan hiburan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Masukan rutinitas anak dirumah ke dalam aktivitas sehari – hari.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>K.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Komplikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hernia serebri</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kejang</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Renjatan</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">KONSEP KEPERAWATAN</span></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">ANAK DENGAN HIDROSEFALUS</span></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">I</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">. <b>PENGKAJIAN</b></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -135.45pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">A. Anamnesa.</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -156.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">a. Insiden : kelaliran denga hidrosefalus terjadi pada 5,8 bayi dai 10.000 kelahiran hidup</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -58.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">a.1. Hidrosefalus dengan spinabifida terdapat kira-kira 3-4 bayi dari 1000 kelahiran hidup</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -58.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">a.2.<span> </span>Type hidrosefalus obstruksi terdapat 99 % kasus pada anak-anak.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -81pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">b. Riwayat kesehatan masa lalu:</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 78pt; text-align: justify; text-indent: -55.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">b.1Terutama adanya riwayat luka / trauma dikepala atau infeksi di sebral</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -2cm;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">c. Riwayat kahamilan dan persalinan :</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 78pt; text-align: justify; text-indent: -55.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">c.1.Kelahiran yang premature</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 78pt; text-align: justify; text-indent: -55.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">c.2.Neonatal meningitis</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 78pt; text-align: justify; text-indent: -55.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">c.3.<span> </span>Perdarahan subaracnoid</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 78pt; text-align: justify; text-indent: -55.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">c.4.<span> </span>Infeksi intra uterin</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 78pt; text-align: justify; text-indent: -55.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">c.5.<span> </span>Perdarahan perinatal,trauma/cidera persalinan.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -134.25pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">B. Pemeriksaan Fisik</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -156.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">-<span> </span>Biasanya adanya myelomeningocele, penguran lingkar kepala (Occipitifrontal)</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -156.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">-<span> </span>Pada hidrosefalus didapatkan :</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -156.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">-<span> </span>Tanda – tanda awal :</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Mata juling</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Sakit kepala</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Lekas marah</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Lesu</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Menangis jika digendong dan diam bila berbaring</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Mual dan muntah yang proyektil</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Melihat kembar</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Ataksia</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Perkembangan yang berlangsung lambat</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Pupil oedema</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Respon pupil terhadap cahaya lambat dan tidak sama</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Biasanya diikuti : perubahan tingkat kesadaran, opistotonus dan spastik pada</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">ekstremitas bawah</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Kesulitan dalam pemberian makanan dan menelan</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 156.75pt; text-align: justify; text-indent: -120.75pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Gangguan cardio pulmoner</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 13.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tanda-tanda selanjutnya :</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Nyeri kepala kepala diikuti dengan muntah-muntah</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Pupil oedema</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Strabismus</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Peningkatan tekanan darah</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Heart lambat</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Gangguan respirasi</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Kejang</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Letargi</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Muntah</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Tanda-tanda ekstrapiramidal/ ataksia</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Lekas marah</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Lesu</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Apatis</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Kebingungan</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Sering kali inkoheren</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 149pt; text-align: justify; text-indent: -113pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o Kebutaaan</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 22.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">C. Pemeriksaan Penunjang.</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Skan temograsfi komputer ( CT-Scan) mempertegas adanya dilatasi ventrikel dan membantui dalam memgidentifikasi kemungkinan penyebabnya( Neoplasma, kista,malformasi konginetal atau perdarahan intra kranial )</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Fungsi ventrikel kadang digunakan untiuk menukur tekanan intra kranial menghilangkan cairan serebrospinal untuk kultur (aturan ditentukan untuk pengulangan pengaliran).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">EEG : untuk mengetahui kelainan genetik atau metabolic</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Transluminasi : Untuk mengetahui apakah adanya kelainan dalam kepala</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">MRI : ( Magnetik resonance imaging ) : memberi informasi mengenai stuktur otak tanpa kena radiasi</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">II.DIAGNOSA KEPERAWATAN</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 22.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">A. Pre Operatif</span></b></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-align: justify; text-indent: -22.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Resiko tinggi injuri berhubungan dengan peningkatan tekanan intra kranial</span><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o <b>Data obyektif</b> : Tidak sadar, panas( 38 C), muntah tanpa proyektil, strabismus. serta gelisah,paralisa.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 70.9pt; text-indent: -48.4pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">o <b>Data Subyektif</b> : Orangnya mengatakan anaknya tidak sadar ,muntah tubuhnya panas..</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -38.05pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tujuan :</span></i></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -34.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">- Tidak terjadi peningkatan tekanan intra kranial dengan kriteria :</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">- Tidak menunjukkan adanya tanda-tanda peningkatan tekanan intra kranial ( mual, muntah, kejang, gelisah ).</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-indent: -27pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tindakan keperawatan :</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 163.05pt; text-indent: -140.55pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Observasi ketat tanda-tanda peningkatan tekanan intra kranial.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 163.05pt; text-indent: -131.55pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Untuk mengetahui secara dini peningkatan TIK</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 163.05pt; text-indent: -140.55pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tentukan skala tingkat kesadaran</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.5pt; text-indent: -54pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :Menurunnya kesadaran menunjukkan adanya tanda-tanda adanya peningkatan TIK.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 85.5pt; text-indent: -63pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Ajari keluarga mengenai tanda-tanda peningkatan tekanan intra kranial</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 163.05pt; text-indent: -131.55pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :Keluarga dapat berpartisipasi dalam perawatan anaknya.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 163.05pt; text-indent: -140.55pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kolaborasi</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 163.05pt; text-indent: -131.55pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :Dapat mencegah atau mempercepat proses penyebuhan penyakit.</span></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-indent: -22.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Gangguan rasa nyaman: Nyeri sehubungan dengan meningkatkanya tekanan intrakranial .</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -9pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Data Indikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> : Adanya keluahan Nyeri Kepala, Meringis atau menangis, gelisah, kepala membesar</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 4.5pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tujuan</span></i></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> ; Klien akan mendapatkan kenyamanan, nyeri kepala berkurang</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 4.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tindakan keperawatan :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -9pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Jelaskan Penyebab nyeri.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -9pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Atur posisi Klien</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -9pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Ajarkan tekhnik relaksasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -9pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kolaborasi dengan tim medis untuk pemberian Analgesik</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-align: justify; text-indent: -22.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Resiko terhadap perubahan pertumbuhan dan perkembangan berhubungan dengan kerusakan kemampuan untuk mencapai tugas perkembangan</span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 4.5pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tujuan : </span></i></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tidak terjadi gangguan pertumbuhan dan perkembangan pada anak.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 4.5pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tindakan keperawatan</span></i></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">:</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Observasi tanda dan gejala gangguan perkembangan secara dini</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :Akan mengetahui secara dini kelainan atau penyimpangan dari keadaan normal.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kolaborasi untuk tindakan pembedahan</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional : Membantu mempercepatan proses penyembuhan.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 13.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">B. Persiapan operasi</span></b></div><div class="MsoListParagraph" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-align: justify; text-indent: -22.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kecemasan Orang tua sehubungan dengan keadaan anak yang akan mengalami operasi.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 13.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Data Indikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> : Ekspresi verbal menunjukkan kecemasan akan keadaan anaknya.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 13.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> : Kecemasan orang tua berkurang atau dapat diatasi.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 13.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tindakan Keperawatan :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Menjelaskan tentang hidrosefalus, anatomi ventrikel, maksud dasar dari shunt. Gunakan diagram dan sampel shunt, jika tersedia bantu memberi penjelasan iformasi yang diterima. Juga jelaskan tujuan berbagai tindakan test diagnostik yang disarankan dan prosedur yang akan dilakukan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional</span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> : Memberikan penjelasan akan membantu penurunan ketakutan dan kecemasan dan meningkatkan penerimaan terhadap kondisi anak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan gamnbaran tindakan perioperative</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional</span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> : Penjelasan terhadap kegiatan ini akan meyakinkan orang tua bahwa mereka harus sadar bahwa anak akan menjalani hal ini dan bantu untuk memberikan dorongan berpartisipasi dalam kegiatan persiapan prabedah, jika memungkinkan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan waktu orang tua mengajukan pertanyaan dan mengekspresikan ketakutan dan perhatiannya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional </span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">: Orang tua membutuhkan waktu menyesuaikan diri dengan informasi sehingga mereka dapat membentuk pertanyaan dan mengekspresikan ketakutan dan perhatiannya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Bantu anak untuk mempersiapkan guna tinggal rawat di rumah sakit dan pembedahan, penggunaan boneka, alat-alat rumah sakit yang tersedia, dan diagram dan video yang tepat sesuai tingkat perkembangan anak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional </span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">: Mendemonstrasikan dengan menggunakan boneka sangat tepat digunakan untuk membantu menngani anak yang terjadi selama tinggal di rumah sakit. Diagram, video, buku-buku, dan diskusi mungkin akan lebih tepat pada anak yang lebih besar.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan penguatan terhadap penjelasan ahli bedah</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasiona</span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">l : Orang tua dan anak sering menerima terlalu banyak informasi dalam waktu yang singkat. Ulangi penjelasan untuk membantu pemahaman kondisi anak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rujuk orang tua pada pekerja sosial atau tenaga pelayanan sosial sesuai kebutuhan.<br />
<i>Rasional</i> : Pekerja sosial dapat memberikan konseling secara seksama untuk membantu orang tua menyesuaikan diri dengan kondisi anak dan tinggal rawat di rumah sakit dan dapat membantu perencana selanjutnya dan merujuk pada oraganisasi kemasyarakatan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 13.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">5. Potensial Kekurangan cairan dan elektrolit sehubungan dengan intake yang kurang diserta muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 13.5pt; text-align: justify; text-indent: -13.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Data </span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">I<b>ndikasi </b>; keluhan Muntah, Jarang minum.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 13.5pt; text-align: justify; text-indent: -13.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> : Tidak terjadi kekurangan cairan dan elektrolit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 13.5pt; text-align: justify; text-indent: -13.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tindakan keperawatan:</span></b></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 13.5pt; text-align: justify; text-indent: 4.5pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· <span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Observasi ketat intake dan output</span><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :Menentukan data dasar dari pada cairan tubuh.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -10.35pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· <span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kolaborasi dalam pemeriksaan laboratorium</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: 3.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :Mengkaji hidrasi dan keefektifan / kebutuhan intervensi</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -67.05pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;">· <span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan cairan infus sesuai pesanan</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -53.55pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional : Mempertahan volume sirkulasi cairan dalam tubuh</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 13.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">C<a href="" name="_GoBack"></a>. Post – Operatif</span></b></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">6. <span> </span>Gangguan rasa nyaman : Nyeri sehubungan dengan tekanan pada kulit yang dilakukan shunt.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Data Indikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> ; adanya keluhan nyeri, Ekspresi non verbal adanya nyeri.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> : Rasa Nyaman Klien akan terpenuhi, Nyeri berkurang</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Tindakan Keperawatan :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Beri kapas secukupnya dibawa telinga yang dibalut.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Aspirasi shunt (Posisi semi fowler), bila harus memompa shunt, maka pemompaan dilakukan perlahan – lahan dengan interval yang telah ditentukan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kolaborasi dengan tim medis bila ada kesulitan dalam pemompaan shunt.<br />
Berikan posisi yang nyama. Hindari posisi p[ada tempat dilakukan shunt.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Observasi tingkat kesadaran dengan memperhatikan perubahan muka (Pucat, dingin, berkeringat)</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kaji orisinil nyeri : Lokasi dan radiasinya</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 13.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">7. Resiko tinggi terjadinya gangguan nutrisi : kurang dari kebutuhan tubuh sehubungan dengan intake yang tidak adekuat.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Data Indikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> ; Adanya keluhan kesulitan dalam mengkonsumsi makanan.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tujua</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">n : Tidak terjadi gangguan nutrisil.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rencana Intervensi :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan makanan lunak tinggi kalori tinggi protein.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan klien makan dengan posisi semi fowler dan berikan waktu yang cukup untuk menelan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Ciptakan suasana lingkungan yang nyaman dan terhindar dari bau – bauan yang tidak enak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Monitor therapi secara intravena.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Timbang berta badan bila mungkin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Jagalah kebersihan mulut ( Oral hygiene)</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan makanan ringan diantara waktu makan</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">8. <span> </span>Resiko tinggi terjadinya infeksi sehubungan dengan infiltrasi bakteri melalui shunt.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-align: justify; text-indent: -22.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> : Tidak terjadi infeksi / Klien bebas dari infeksi.</span><span style="font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-align: justify; text-indent: -22.5pt;"><span style="font-size: 10pt; line-height: 150%;"><span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tindakan keperawatan</span></b><b><span style="font-size: 10pt; line-height: 150%;"> :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kaji suhu tubuh anak yang tidak stabil, penurunan LOC, kehilangan nafsu makan, muntah, peningkatan sel darah putih, dan pembengkakan atau kemerahan sepanjang saluran shunt.</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional : </span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tanda ini memberikan petunjuk adanya infeksi, biasanya terjadi dalam bulan pertama setelah insersi shunt</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Monitor suhu badan anak setiap 4 jam</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional : </span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Penurunan suhu badan adalah tanda awal infeksi pada neonatus, dan penimngkatan suhu badan adalah tanda awal terjadinya infeksi pada anak</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Posisi baring anak yang tidak menahan beraty pada bagian katup pada 24 sampai 48 jam pertama setelah pembedahan.</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> Posisi dimana kepala pada posisi yang tepat membantu mencegah kerusakan kulit atau sekitar pompa shunt</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Kaji area insisi setiap 4 jam, lihat adanya pengaliran cairan dari luka dan adanya pembengkakan. Catat jumlah dan jenis cairan yang keluar dari luka insisi.</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Pembengkakan disekitar pompa, saluran shunt, atau insisi bedah—dengan atau tanpa grainase—mungkin merupakan tanda awal infeksi pada shunt.</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan antibiotik sesuai petunjuk</span><b><span style="font-size: 10pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Rasional :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> Antibitik yang bersifat profilaksis biasanya diberikan saat pembedahan dan dilanjutkan pada 48 sampai 72 jam setelah pembedahan.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 22.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">9. Resiko tinggi terjadi kerusakan integritas kulit dan kontraktur sehubungan dengan imobilisasi.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"> ; Pasien bebas dari kerusakan integritas kulit dan kontraktur.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Tindakan Keperawatan :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Mobilisasi klien (Miki dan Mika) setiap 2 jam.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Obsevasi terhadap tanda – tanda kerusakan integritas kulit dan kontrkatur.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Jagalah kebersihan dan kerapihan tempat tidur.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Berikan latihan secara pasif dan perlahan – lahan</span></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">BAB IV</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div align="center" class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">PENUTUP</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">A. Kesimpulan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Hidrosefalus adalah kelainan patologis otak yang mengakibatkan bertambahnya cairan serebrospinal dengan tekanan intrakranial yang meninggi, sehingga terdapat pelebaran ventrikel. </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Insiden hidrosefalus antara 0,2- 4 setiap 1000 kelahiran. Insiden hidrosefalus konginetal adalah 0,5- 1,8 pada tiap 1000 kelahiran dan 11 % - 43 % disebabkan oleh stenosis aquaductus serebri. Tidak ada perbedaan bermakna insiden untuk kedua jenis kelamin, juga dalam hal perbedaan ras. Hidrosefalus dapat terjadi pada semua umur.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Pada dasarnya ada 3 prinsip dalam pengobatan hidrosefalus, yaitu :</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>a)mengurangi produksi CSS</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">b)Mempengaruhi hubungan antara tempat produksi CSS dengan tempat absorbsi</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">c)Pengeluaran likuor ( CSS ) kedalam organ ekstrakranial.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">Hal yang sangat penting dalam penanganan kasus hidrosefalus ini adalaqh kejadian infeksi akibat penatalaksanaan dan asuhan yang diberikan tidak tepat. </span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;">B.Saran</span></b><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Diharapkan kepada orang tua yang mendapatkan anak dengan kasus hidrosefalus untuk tidak berkecil hati karena ada masih ada cara pengobatan yang dapat dilakukan. Pengobatan tersebut dapat membantu anak tersebut untuk proses tumbuh kembangnya dikemudian hari.</span></div><div class="MsoNormal" style="color: #d0e0e3; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span> </span>Bagi petugas kesehatan diharapkan dapat melakukan penatalaksanaan dan asuhan yang adekuat dan hati-hati untuk mencegah terjadinya infeksi sehingga dapat menurunkan angka kematian pada bayi.</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-5562091031979041782011-02-22T17:42:00.000-08:002011-02-22T17:42:20.545-08:00Askep Abortus<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="postmetadata" style="line-height: 150%; text-align: center;"><b><span style="font-size: 16pt; line-height: 150%;">ABORTUS</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Definisi</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus adalah keluarnya janin sebelum mencapai viabilitas. Dimana masa gestasi belum mencapai usia 22 minggu dan beratnya kurang dari 500gr (Derek liewollyn&Jones, 2002).</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Terdapat beberapa macam kelainan dalam kehamilan dalam hal ini adalah abortus yaitu abortus spontan, abortus buatan, dan terapeutik. Abortus spontan terjadi karena kualitas sel telur dan sel sperma yang kurang baik untuk berkembang menjadi sebuah janin. Abortus buatan merupakan pengakhiran kehamilan dengan disengaja sebelum usia kandungan 28 minggu.Pengguguran kandungan buatan karena indikasi medik disebut abortus terapeutik (Prawirohardjo, S, 2002). Menariknya pembahasan tentang abortus dikarenakan pemahaman di kalangan masyarakat masih merupakan suatu tindakan yang masih dipandang sebelah mata. Oleh karena itu, pandangan yang ada di dalam masyarakat tidak boleh sama dengan pandangan yang dimiliki oleh tenaga kesehatan, dalam hal ini adalah perawat setelah membaca pokok bahasan ini.<br />
Angka kejadian abortus diperkirakan frekuensi dari abortus spontan berkisar 10-15%. Frekuensi ini dapat mencapai angka 50% jika diperhitungkan banyak wanita mengalami kehamilan dengan usia sangat dini, terlambatnya menarche selama beberapa hari, sehingga seorang wanita tidak mengetahui kehamilannya. Di Indonesia, diperkirakan ada 5 juta kehamilan per-tahun, dengan demikian setiap tahun terdapat 500.000-750.000 janin yang mengalami abortus spontan.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus terjadi pada usisa kehamilan kurang dari 8 minggu, janin dikeluarkan seluruhnya karena villi koriales belum menembus desidua secara mendalam. Pada kehamilan 8–14 minggu villi koriales menembus desidua secara mendalam, plasenta tidak dilepaskan sempurna sehingga banyak perdarahan. Pada kehamilan diatas 14 minggu, setelah ketubah pecah janin yang telah mati akan dikeluarkan dalam bentuk kantong amnion kosong dan kemudian plasenta (Prawirohardjo, S, 2002).</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Peran perawat dalam penanganan abortus dan mencegah terjadinya abortus adalah dengan memberikan asuhan keperawatan yang tepat. Asuhan keperawatan yang tepat untuk klien harus dilakukan untuk meminimalisir terjadinya komplikasi serius yang dapat terjadi seiring dengan kejadian abortus.<a href="" name="Abortus_spontanea_.28abortus_yang_berlan"></a></div><h2 style="line-height: 150%; margin-top: 0cm; text-align: justify;"><span class="says"><span style="font-size: 14pt; line-height: 150%;">Klasifikasi</span></span><span style="font-size: 14pt; line-height: 150%;"></span></h2><h2 style="line-height: 150%; margin-top: 0cm; text-align: justify;"><span class="says"><span style="font-size: 12pt; line-height: 150%;">1. Abortus spontanea (abortus yang berlangsung tanpa tindakan)</span></span><span style="font-size: 12pt; line-height: 150%;"></span></h2><div class="postmetadata" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">Yaitu:</div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus imminens : Peristiwa terjadinya perdarahan dari uterus pada kehamilan sebelum 20 minggu, dimana hasil konsepsi masih dalam uterus, dan tanpa adanya <a href="http://id.wikipedia.org/w/index.php?title=Dilatasi&action=edit&redlink=1" title="Dilatasi (halaman belum tersedia)">dilatasi</a> <a href="http://id.wikipedia.org/w/index.php?title=Serviks&action=edit&redlink=1" title="Serviks (halaman belum tersedia)">serviks</a>. </li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus insipiens : Peristiwa <a href="http://id.wikipedia.org/w/index.php?title=Perdarahan&action=edit&redlink=1" title="Perdarahan (halaman belum tersedia)">perdarahan</a> <a href="http://id.wikipedia.org/wiki/Uterus" title="Uterus">uterus</a> pada kehamilan sebelum 20 minggu dengan adanya dilatasi serviks <a href="http://id.wikipedia.org/w/index.php?title=Uteri&action=edit&redlink=1" title="Uteri (halaman belum tersedia)">uteri</a> yang meningkat, tetapi hasil konsepsi masih dalam uterus. </li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus inkompletus : Pengeluaran sebagian hasil konsepsi pada kehamilan sebelum 20 minggu dengan masih ada sisa tertinggal dalam uterus. </li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus kompletus : Semua hasil konsepsi sudah dikeluarkan. </li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus servicalis adalah keluarnya hasil konsepsi dari uterus dihalangi oleh ostium uterus eksternum yang tidak membuka, sehingga semuanya terkumpul dalam kanalis servikalis uterus menjadi besar, kurang lebih bundar dengan dinding menipis.</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Missed abortion adalah kematian janin berusia sebelum 20 minggu, tetapi janin mati itu tidak dikeluarkan selama 8 minggu atau lebih.</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus habitualis adalah abortus yang berulang dengan frekuensi lebih dari 3 kali.</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus septik adalah abortus infeksius berat disertai dengan penyebaran kuman atau toksinke dalam peredaran darah atau peritonium. </li>
</ul><h3 style="line-height: 150%; margin-top: 0cm; text-align: justify;"><a href="" name="Abortus_provokatus_.28abortus_yang_senga"></a><span style="font-size: 12pt; line-height: 150%;">2. <span class="says">Abortus provokatus (abortus yang sengaja dibuat)</span></span></h3><div class="postmetadata" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;">Yaitu:</div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Menghentikan kehamilan sebelum janin dapat hidup di luar tubuh ibu. Pada umumnya dianggap bayi belum dapat hidup diluar <a href="http://id.wikipedia.org/wiki/Kandungan" title="Kandungan">kandungan</a> apabila kehamilan belum mencapai umur 28 minggu, atau <a href="http://id.wikipedia.org/w/index.php?title=Berat_badan&action=edit&redlink=1" title="Berat badan (halaman belum tersedia)">berat badanbayi</a> belum 1000 gram, walaupun terdapat kasus bahwa bayi dibawah 1000 gram dapat terus hidup.<a href="" name="Macam_abortus_provokatus"></a> </li>
</ul><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Etiologi</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus dapat terjadi karena beberapa sebab yaitu :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 31.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kelainan pertumbuhan hasil konsepsi, biasanya menyebabkan abortus pada kehamilan sebelum usia 8 minggu. Faktor yang menyebabkan kelainan ini adalah :<br />
a. Kelainan kromosom, terutama trimosoma dan monosoma X</div><div class="MsoNormal" style="line-height: 150%; margin-left: 31.5pt; text-align: justify;">b. Lingkungan sekitar tempat impaltasi kurang sempurna</div><div class="MsoNormal" style="line-height: 150%; margin-left: 31.5pt; text-align: justify;">c. Pengaruh teratogen akibat radiasi, virus, obat-obatan temabakau dan alcohol</div><div class="MsoNormal" style="line-height: 150%; margin-left: 31.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kelainan pada plasenta, misalnya endarteritis vili korialis karena hipertensi menahun</div><div class="MsoNormal" style="line-height: 150%; margin-left: 31.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Faktor maternal seperti pneumonia, typus, anemia berat, keracunan dan toksoplasmosis.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 31.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kelainan traktus genetalia, seperti inkompetensi serviks (untuk abortus pada trimester kedua), retroversi uteri, mioma uteri dan kelainan bawaan uterus.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b>Penyebab dari segi Maternal</b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Penyebab secara umum:</div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><a href="http://id.wikipedia.org/w/index.php?title=Infeksi_akut&action=edit&redlink=1" title="Infeksi akut (halaman belum tersedia)">Infeksi akut</a> </li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/wiki/Virus" title="Virus">virus</a>, misalnya <a href="http://id.wikipedia.org/wiki/Cacar" title="Cacar">cacar</a>, <a href="http://id.wikipedia.org/wiki/Rubella" title="Rubella">rubella</a>, <a href="http://id.wikipedia.org/wiki/Hepatitis" title="Hepatitis">hepatitis</a>.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/wiki/Infeksi" title="Infeksi">Infeksi</a> <a href="http://id.wikipedia.org/wiki/Bakteri" title="Bakteri">bakteri</a>, misalnya <a href="http://id.wikipedia.org/w/index.php?title=Streptokokus&action=edit&redlink=1" title="Streptokokus (halaman belum tersedia)">streptokokus</a>.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/wiki/Parasit" title="Parasit">Parasit</a>, misalnya <a href="http://id.wikipedia.org/wiki/Malaria" title="Malaria">malaria</a>.</div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Infeksi <a href="http://id.wikipedia.org/wiki/Kronis" title="Kronis">kronis</a> </li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/wiki/Sifilis" title="Sifilis">Sifilis</a>, biasanya menyebabkan abortus pada trimester kedua.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Tuberkulosis_paru&action=edit&redlink=1" title="Tuberkulosis paru (halaman belum tersedia)">Tuberkulosis paru</a> aktif.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">Keracunan, misalnya keracunan tembaga, timah, air raksa, dll.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Penyakit_kronis&action=edit&redlink=1" title="Penyakit kronis (halaman belum tersedia)">Penyakit kronis</a>, misalnya : </div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/wiki/Hipertensi" title="Hipertensi">hipertensi</a></div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Nephritis&action=edit&redlink=1" title="Nephritis (halaman belum tersedia)">nephritis</a></div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/wiki/Diabetes" title="Diabetes">diabetes</a></div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Anemia_berat&action=edit&redlink=1" title="Anemia berat (halaman belum tersedia)">anemia berat</a></div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/wiki/Penyakit_jantung" title="Penyakit jantung">penyakit jantung</a></div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Toxemia_gravidarum&action=edit&redlink=1" title="Toxemia gravidarum (halaman belum tersedia)">toxemia gravidarum</a></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">Gangguan <a href="http://id.wikipedia.org/w/index.php?title=Fisiologis&action=edit&redlink=1" title="Fisiologis (halaman belum tersedia)">fisiologis</a>, misalnya <a href="http://id.wikipedia.org/w/index.php?title=Syok&action=edit&redlink=1" title="Syok (halaman belum tersedia)">Syok</a>, ketakutan, dll.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Trauma&action=edit&redlink=1" title="Trauma (halaman belum tersedia)">Trauma</a> fisik.</div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Penyebab yang bersifat <a href="http://id.wikipedia.org/w/index.php?title=Lokal&action=edit&redlink=1" title="Lokal (halaman belum tersedia)">lokal</a>: </li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Fibroid&action=edit&redlink=1" title="Fibroid (halaman belum tersedia)">Fibroid</a>, <a href="http://id.wikipedia.org/w/index.php?title=Inkompetensia_serviks&action=edit&redlink=1" title="Inkompetensia serviks (halaman belum tersedia)">inkompetensia serviks</a>.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Radang_pelvis_kronis&action=edit&redlink=1" title="Radang pelvis kronis (halaman belum tersedia)">Radang pelvis kronis</a>, <a href="http://id.wikipedia.org/w/index.php?title=Endometrtis&action=edit&redlink=1" title="Endometrtis (halaman belum tersedia)">endometrtis</a>.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><a href="http://id.wikipedia.org/w/index.php?title=Retroversi&action=edit&redlink=1" title="Retroversi (halaman belum tersedia)">Retroversi</a> <a href="http://id.wikipedia.org/wiki/Kronis" title="Kronis">kronis</a>.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><a href="http://id.wikipedia.org/wiki/Hubungan_seksual" title="Hubungan seksual">Hubungan seksual</a> yang berlebihan sewaktu hamil, sehingga menyebabkan <a href="http://id.wikipedia.org/w/index.php?title=Hiperemia&action=edit&redlink=1" title="Hiperemia (halaman belum tersedia)">hiperemia</a> dan abortus</div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18pt;">Penyebab dari segi Janin</div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Kematian janin akibat kelainan bawaan. </li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><a href="http://id.wikipedia.org/w/index.php?title=Mola_hidatidosa&action=edit&redlink=1" title="Mola hidatidosa (halaman belum tersedia)">Mola hidatidosa</a>. </li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><a href="http://id.wikipedia.org/w/index.php?title=Penyakit_plasenta&action=edit&redlink=1" title="Penyakit plasenta (halaman belum tersedia)">Penyakit plasenta</a> dan <a href="http://id.wikipedia.org/w/index.php?title=Desidua&action=edit&redlink=1" title="Desidua (halaman belum tersedia)">desidua</a>, misalnya <a href="http://id.wikipedia.org/wiki/Inflamasi" title="Inflamasi">inflamasi</a> dan <a href="http://id.wikipedia.org/w/index.php?title=Degenerasi&action=edit&redlink=1" title="Degenerasi (halaman belum tersedia)">degenerasi</a>. </li>
</ul><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Patofisiologi</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Pada awal abortus terjadi perdarahan desiduabasalis, diikuti dengan nerkrosis jaringan sekitar yang menyebabkan hasil konsepsi terlepas dan dianggap benda asing dalam uterus. Kemudian uterus berkontraksi untuk mengeluarkan benda asing tersebut.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Pada kehamilan kurang dari 8 minggu, villi korialis belum menembus desidua secara dalam jadi hasil konsepsi dapat dikeluarkan seluruhnya. Pada kehamilan 8 sampai 14 minggu, penembusan sudah lebih dalam hingga plasenta tidak dilepaskan sempurna dan menimbulkan banyak perdarahan. Pada kehamilan lebih dari 14 minggu janin dikeluarkan terlebih dahulu daripada plasenta hasil konsepsi keluar dalam bentuk seperti kantong kosong amnion atau benda kecil yang tidak jelas bentuknya (blightes ovum),janin lahir mati, janin masih hidup, mola kruenta, fetus kompresus, maserasi atau fetus papiraseus.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Manifestasi Klinis</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Terlambat haid atau amenorhe kurang dari 20 minggu</div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Pada pemeriksaan fisik : keadaan umum tampak lemah kesadaran menurun, tekanan darah normal atau menurun, denyut nadi normal atau cepat dan kecil, suhu badan normal atau meningkat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Perdarahan pervaginam mungkin disertai dengan keluarnya jaringan hasil konsepsi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Rasa mulas atau kram perut, didaerah atas simfisis, sering nyeri pingang akibat kontraksi uterus</div><div class="MsoNormal" style="line-height: 150%; margin-left: 31.5pt; text-align: justify; text-indent: -18pt;">Pemeriksaan ginekologi :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 40.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Inspeksi Vulva : perdarahan pervaginam ada atau tidak jaringan hasil konsepsi, tercium bau busuk dari vulva</div><div class="MsoNormal" style="line-height: 150%; margin-left: 40.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Inspekulo : perdarahan dari cavum uteri, osteum uteri terbuka atau sudah tertutup, ada atau tidak jaringan keluar dari ostium, ada atau tidak cairan atau jaringan berbau busuk dari ostium.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 40.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Colok vagina : porsio masih terbuka atau sudah tertutup, teraba atau tidak jaringan dalam cavum uteri, besar uterus sesuai atau lebih kecil dari usia kehamilan, tidak nyeri saat porsio digoyang, tidak nyeri pada perabaan adneksa, cavum douglas tidak menonjol dan tidak nyeri.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Komplikasi</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Perdarahan, perforasi, syok dan infeksi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Pada missed abortion dengan retensi lama hasil konsepsi dapat terjadi kelainan pembekuan darah</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Pemeriksaan Penunjang </span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Tes Kehamilan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Positif bila janin masih hidup, bahkan 2-3 minggu setelah abortus</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Pemeriksaaan Doppler atau USG untuk menentukan apakah janin masih hidup</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Pemeriksaan kadar fibrinogen darah pada missed abortion</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Diagnosa Banding</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Kehamilan etopik terganggu, mola hidatidosa, kemamilan dengan kelainan serviks. Abortion imiteins perlu dibedakan dengan perdarahan implantasi yang biasanya sedikit, berwarna merah, cepat terhenti, dan tidak disertai mules-mules.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Penatalaksanaan </span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Abortus dapat dibagi dalam 2 golongan, yaitu :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Abortus spontaneus</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Yaitu abortus yang terjadi dengan tidak didahului faktor-faktor mekanis atau medisinalis, tetapi karena faktor alamiah. Aspek klinis abortus spontaneus meliputi :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Abortus Imminens</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Abortus Imminens adalah peristiwa terjadinya perdarahan dari uterus pada kehamilan sebelum 20 minggu, dimana hasil konsepsi masih dalam uterus, dan tanpa adanya dilatasi serviks. Diagnosis abortus imminens ditentukan apabila terjadi perdarahan pervaginam pada paruh pertama kehamilan. Yang pertama kali muncul biasanya adalah perdarahan, dari beberapa jam sampai beberapa hari kemudian terjadi nyeri kram perut. Nyeri abortus mungkin terasa di anterior dan jelas bersifat ritmis, nyeri dapat berupa nyeri punggung bawah yang menetap disertai perasaan tertekan di panggul, atau rasa tidak nyaman atau nyeri tumpul di garis tengah suprapubis. Kadang-kadang terjadi perdarahan ringan selama beberapa minggu. Dalam hal ini perlu diputuskan apakah kehamilan dapat dilanjutkan.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Sonografi vagina,pemeriksaan kuantitatif serial kadar gonadotropin korionik (hCG) serum, dan kadar progesteron serum, yang diperiksa tersendiri atau dalam berbagai kombinasi, untuk memastikan apakah terdapat janin hidup intrauterus. Dapat juga digunakan tekhnik pencitraan colour and pulsed Doppler flow per vaginam dalam mengidentifikasi gestasi intrauterus hidup. Setelah konseptus meninggal, uterus harus dikosongkan. Semua jaringan yang keluar harus diperiksa untuk menentukan apakah abortusnya telah lengkap. Kecuali apabila janin dan plasenta dapat didentifikasi secara pasti, mungkin diperlukan kuretase. Ulhasonografi abdomen atau probe vagina Dapat membantu dalam proses pengambilan keputusan ini. Apabila di dalam rongga uterus terdapat jaringan dalam jumlah signifikan, maka dianjurkan dilakukan kuretase.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Penanganan abortus imminens meliputi :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Istirahat baring. Tidur berbaring merupakan unsur penting dalam pengobatan, karena cara ini menyebabkan bertambahnya aliran darah ke uterus dan berkurangnya rangsang mekanik.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Terapi hormon progesteron intramuskular atau dengan berbagai zat progestasional sintetik peroral atau secara intramuskular.Walaupun bukti efektivitasnya tidak diketahui secara pasti.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Pemeriksaan ultrasonografi untuk menentukan apaka}r janin masih hidup.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Abortus Insipiens</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Abortus Insipiens adalah peristiwa perdarahan uterus pada kehamilan sebelum 20 minggu dengan adanya dilatasi serviks uteri yang meningkat tetapi hasil konsepsi masih dalam uterus. Dalam hal ini rasa mules menjadi lebih sering dan kual perdarahan bertambah. Pengeluaran hasil konsepsi dapat dilaksanakan dengan kuret vakum atau dengan cunam ovum, disusul dengan kerokan.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Penanganan Abortus Insipiens meliputi :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Jika usia kehamilan kurang 16 minggu, lakukan evaluasi uterus dengan aspirasi vakum manual. Jika evaluasi tidak dapat, segera lakukan:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Berikan ergomefiin 0,2 mg intramuskuler (dapat diulang setelah 15 menit bila perlu) atau misoprostol 400 mcg per oral (dapat diulang sesudah 4 jam bila perlu).</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Segera lakukan persiapan untuk pengeluaran hasil konsepsi dari uterus.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Jika usia kehamilan lebih 16 minggu :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Tunggu ekspulsi spontan hasil konsepsi lalu evaluasi sisa-sisa hasil konsepsi.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>ika perlu, lakukan infus 20 unit oksitosin dalam 500 ml cairan intravena (garam fisiologik atau larutan ringer laktat dengan kecepatan 40 tetes permenit untuk membantu ekspulsi hasil konsepsi.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Pastikan untuk tetap memantau kondisi ibu setelah penanganan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Abortus lnkompletus</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Abortus Inkompletus adalah pengeluaran sebagian hasil konsepsi pada kehamilan sebelum 20 minggu dengan masih ada sisa tertinggal dalam uterus. Apabila plasenta (seluruhnya atau sebagian) tertahan di uterus, cepat atau lambat akan terjadi perdarahan yang merupakan tanda utama abortus inkompletus. Pada abortus yang lebih lanjut, perdarahan kadang-kadang sedemikian masif sehingga menyebabkan hipovolemia berat.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Penanganan abortus inkomplit :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Jika perdarahant idak seberapab anyak dan kehamilan kurang 16 minggu, evaluasi dapat dilakukan secara digital atau dengan cunam ovum untuk mengeluarkan hasil konsepsi yang keluar melalui serviks. Jika perdarahan berhenti, beri ergometrin 0,2 mg intramuskulera taum iso prostol4 00 mcg per oral.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Jika perdarahanb anyak atau terus berlangsungd an usia kehamilan kurang 16 minggu, evaluasi hasil konsepsi dengan :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Aspirasi vakum manual merupakan metode evaluasi yang terpilih. Evakuasi dengan kuret tajam sebaiknya hanya dilakukan jika aspirasi vakum manual tidak tersedia.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Jika evakuasi belum dapat dilakukan segera beri ergometrin 0,2 mg intramuskuler (diulang setelah 15 menit bila perlu) atau misoprostol 400 mcg peroral (dapat diulang setelah 4 jam bila perlu).</div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Jika kehamilan lebih dari 16 minggu:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Berikan infus oksitosin 20 unit dalam 500 ml cairan intravena (garam fisiologik atau ringer laktat) dengan k ecepatan 40 tetes permenit sampai terjadi ekspulsi hasil konsepsi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Jika perlu berikan misoprostol 200 mcg per vaginam setiap 4 jam sampai terjadi ekspulsi hasil konsepsi (maksimal 800 mcg)</div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Evaluasi sisa hasil konsepsi yang tertinggal dalam uterus.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Courier New";"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Pastikan untuk tetap memantau kondisi ibu setelah penanganan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Abortus Kompletus</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Pada abortus kompletus semua hasil konsepsi sudah dikeluarkan. Pada penderita ditemukan perdarahan sedikit, ostium uteri telah menutup, dan uterus sudah banyak mengecil. Diagnosis dapat dipermudah apabila hasil konsepsi dapat diperiksa dan dapat dinyatakan bahwa semuanya sudah keluar dengan lengkap.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Penderita dengan abortus kompletus tidak memerlukan pengobatan khusus, hanya apabila penderita anemia perlu diberikan tablet sulfas ferrosus 600 mg perhari atau jika anemia berat maka perlu diberikan transfusi darah.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Abortus Servikalis</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Pada abortus servikalis keluarnya hasil konsepsi dari uterus dihalangi oleh ostium uteri eksternum yang tidak membuka, sehingga semuanya terkumpul dalam kanalis servikalis dan serviks uteri menjadi besar, kurang lebih bundar, dengan dinding menipis. Padap emeriksaand itemukan serviks membesar dan di atas ostium uteri eksternum teraba jaringan. Terapi terdiri atas dilatasi serviks dengan busi Hegar dan kerokan untuk mengeluarkan hasil konsepsi dari kanalis servikalis.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Missed Abortion</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Missed abortion adalah kematian janin berusia sebelum 20 minggu, tetapi janin yang telah mati itu tidak dikeluarkan selama 8 minggu atau lebih. Etiologi missed abortion tidak diketahui, tetapi diduga pengaruh hormone progesterone. Pemakaian Hormone progesterone pada abortus imminens mungkin juga dapat menyebabkan missed abortion.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><span> </span></cite><cite><b><span style="font-size: 16pt; font-style: normal; line-height: 150%;">ASUHAN KEPERWATAN</span></b></cite><b><i><span style="font-size: 16pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Pengkajian</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Adapun hal-hal yang perlu dikaji adalah :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><cite>Biodata</cite> : mengkaji identitas klien dan penanggung yang meliputi ; nama, umur, agama, suku bangsa, pendidikan, pekerjaan, status perkawinan, perkawinan ke- , lamanya perkawinan dan alamat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><cite>Keluhan utama</cite> : Kaji adanya menstruasi tidak lancar dan adanya perdarahan pervaginam berulang</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><cite>Riwayat kesehatan</cite> , yang terdiri atas : </div><div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b>Riwayat kesehatan sekarang </b>yaitu keluhan sampai saat klien pergi ke Rumah Sakit atau pada saat pengkajian seperti perdarahan pervaginam di luar siklus haid, pembesaran uterus lebih besar dari usia kehamilan.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b>Riwayat kesehatan masa lalu</b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-align: justify;"><cite>Riwayat pembedahan</cite> : Kaji adanya pembedahan yang pernah dialami oleh klien, jenis pembedahan , kapan , oleh siapa dan di mana tindakan tersebut berlangsung.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><cite>Riwayat penyakit yang pernah dialami</cite> : Kaji adanya penyakit yang pernah dialami oleh klien misalnya DM , jantung , hipertensi , masalah ginekologi/urinary , penyakit endokrin , dan penyakit-penyakit lainnya.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify;"><cite>Riwayat kesehatan keluarga</cite> : Yang dapat dikaji melalui genogram dan dari genogram tersebut dapat diidentifikasi mengenai penyakit turunan dan penyakit menular yang terdapat dalam keluarga.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><cite>Riwayat kesehatan reproduksi</cite> : Kaji tentang mennorhoe, siklus menstruasi, lamanya, banyaknya, sifat darah, bau, warna dan adanya dismenorhoe serta kaji kapan menopause terjadi, gejala serta keluahan yang menyertainya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><cite>Riwayat kehamilan , persalinan dan nifas</cite> : Kaji bagaimana keadaan anak klien mulai dari dalam kandungan hingga saat ini, bagaimana keadaan kesehatan anaknya.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><cite>Riwayat seksual</cite> : Kaji mengenai aktivitas seksual klien, jenis kontrasepsi yang digunakan serta keluahn yang menyertainya.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><cite>Riwayat pemakaian obat </cite>: Kaji riwayat pemakaian obat-obatankontrasepsi oral, obat digitalis dan jenis obat lainnya.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><cite>Pola aktivitas sehari-hari</cite> : Kaji mengenai nutrisi, cairan dan elektrolit, eliminasi (BAB dan BAK), istirahat tidur, hygiene, ketergantungan, baik sebelum dan saat sakit.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><b>Pemeriksaan fisik, meliputi : </b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><cite>Inspeksi</cite> adalah proses observasi yang sistematis yang tidak hanya terbatas pada penglihatan tetapi juga meliputi indera pendengaran dan penghidung.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="FI">Hal yang diinspeksi antara lain : </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="FI">mengobservasi kulit terhadap warna, perubahan warna, laserasi, lesi terhadap drainase, pola pernafasan terhadap kedalaman dan kesimetrisan, bahasa tubuh, pergerakan dan postur, penggunaan ekstremitas, adanya keterbatasan fifik, dan seterusnya</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><cite>Palpasi </cite>adalah menyentuh atau menekan permukaan luar tubuh dengan jari. </div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI">Sentuhan : merasakan suatu pembengkakan, mencatat suhu, derajat kelembaban dan tekstur kulit atau menentukan kekuatan kontraksi uterus. </span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI">Tekanan : menentukan karakter nadi, mengevaluasi edema, memperhatikan posisi janin atau mencubit kulit untuk mengamati turgor. </span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI">Pemeriksaan dalam : menentukan tegangan/tonus otot atau respon nyeri yang abnormal</span></li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><cite><span lang="FI">Perkusi</span></cite><span lang="FI"> adalah melakukan ketukan langsung atau tidak langsung pada permukaan tubuh tertentu untuk memastikan informasi tentang organ atau jaringan yang ada dibawahnya. </span></div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI">Menggunakan jari : ketuk lutut dan dada dan dengarkan bunyi yang menunjukkan ada tidaknya cairan , massa atau konsolidasi. </span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="FI">Menggunakan palu perkusi : ketuk lutut dan amati ada tidaknya refleks/gerakan pada kaki bawah, memeriksa refleks kulit perut apakah ada kontraksi dinding perut atau tidak</span></li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><cite><span lang="FI">Auskultasi</span></cite><span lang="FI"> adalah mendengarkan bunyi dalam tubuh dengan bentuan stetoskop dengan menggambarkan dan menginterpretasikan bunyi yang terdengar. Mendengar : mendengarkan di ruang antekubiti untuk tekanan darah, dada untuk bunyi jantung/paru abdomen untuk bising usus atau denyut jantung janin.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="FI">(Johnson & Taylor, 2005 : 39)</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><b><span lang="FI">Pemeriksaan laboratorium : </span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI">Darah dan urine serta pemeriksaan penunjang : rontgen, USG, biopsi, pap smear. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI">Keluarga berencana : Kaji mengenai pengetahuan klien tentang KB, apakah klien setuju, apakah klien menggunakan kontrasepsi, dan menggunakan KB jenis apa.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><b><span lang="FI">Data lain-lain : </span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="FI">Kaji mengenai perawatan dan pengobatan yang telah diberikan selama dirawat di RS.Data psikososial. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="FI">Kaji orang terdekat dengan klien, bagaimana pola komunikasi dalam keluarga, hal yang menjadi beban pikiran klien dan mekanisme koping yang digunakan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="FI">Status sosio-ekonomi : Kaji masalah finansial klien</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="FI">Data spiritual : Kaji tentang keyakinan klien terhadap Tuhan YME, dan kegiatan keagamaan yang biasa dilakukan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="FI"> </span><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Diagnosa Keperwatan</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><ol start="1" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Devisit Volume Cairan b.d perdarahan</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Perubahan perfusi jaringan yang b.d hipovolemia</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Nyeri b.d kerusakan jaringan intrauteri</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Resiko Infeksi b.d perdarahan, kondisi vulva lembab</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Ansietas b.d kurang pengetahuan</li>
</ol><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><cite><b><span style="font-size: 14pt; font-style: normal; line-height: 150%;">Renacana Intervensi </span></b></cite><b><span style="font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Devisit Volume Cairan b.d Perdarahan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Tujuan :</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Tidak terjadi devisit volume cairan, </div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Kriteria hasil : </u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Seimbang antara intake dan output baik jumlah maupun kualitas.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Rencana keperawatan<span> </span></u></div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Kaji kondisi status hemodinamika</li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Pengeluaran cairan pervaginal sebagai akibat abortus memiliki karekteristik bervariasi</div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Ukur pengeluaran harian</li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Jumlah cairan ditentukan dari jumlah kebutuhan harian ditambah dengan jumlah cairan yang hilang pervaginal</div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Berikan sejumlah cairan pengganti harian</li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Tranfusi mungkin diperlukan pada kondisi perdarahan massif</div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Evaluasi status hemodinamika</li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Penilaian dapat dilakukan secara harian melalui pemeriksaan fisik</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Perubahan perfusi jaringan yang b.d hipovolemia</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Tujuan : </u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Kriteria hasil :</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Perfusi jaringan adekuat dibuktikan dengan denyut jantung janin (DJJ) dalam batas normal</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Rencana keperawatan :</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kaji status fisiologi ibu, status sirkulasi, dan volume darah.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : kejadian perdarahan potensial merusak hasil kehamilan. Kemungkinan menyebabkan hipovolemia hipoksia uteroplasenta.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>kaji DJJ. Catat bradikardi atau takikardi. Catat perubahan pada aktifitas janin.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : mengkaji berlanjutnya hipoksia janin</div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">kaji kehilangan darah ibu karena adanya kontraksi uterus.</li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : kehilangan darah ibu secara berlebihan menurunkan perfusi jaringan</div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">kaji tinggi fundus uteri</li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">rasional : menghilangkan tekanan pada vena kava inferior meningkatkan sirkulasi plasenta/janin dan pertukaran oksigen</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nyeri b.d Kerusakan jaringan intrauteri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Tujuan :</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Klien dapat beradaptasi dengan nyeri yang dialami</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Kriteria hasil :</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Nyeri dapat teratasi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Rencana keperawatan</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kaji kondisi nyeri yang dialami klien</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Pengukuran nilai ambang nyeri dapat dilakukan dengan skala maupun dsekripsi.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Terangkan nyeri yang diderita klien dan penyebabnya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Meningkatkan koping klien dalam melakukan guidance mengatasi nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kolaborasi pemberian analgetika</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Mengurangi onset terjadinya nyeri dapat dilakukan dengan pemberian analgetika oral maupun sistemik dalam spectrum luas/spesifik</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Resiko <span> </span>Infeksi </div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Faktor resiko : faktor perdarahan dan vulva lembab</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Tujuan :</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">Tidak terjadi infeksi selama perawatan perdarahan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Kriteria hasil :</u></div><ol start="1" style="margin-top: 0cm;" type="a"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Tidak ada tanda – tanda infeksi</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">TTV dalam batas normal</li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">c.<span> </span>Hasil laboratorium dalam batas normal: lekosit<br />
<u>Rencana keperawatan</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kaji kondisi keluaran/dischart yang keluar ; jumlah, warna, dan bau</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Perubahan yang terjadi pada dishart dikaji setiap saat dischart keluar. Adanya warna yang lebih gelap disertai bau tidak enak mungkin merupakan tanda infeksi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Terangkan pada klien pentingnya perawatan vulva selama masa perdarahan<br />
Rasional : Infeksi dapat timbul akibat kurangnya kebersihan genital yang lebih luar</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Lakukan pemeriksaan biakan pada dischart</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Berbagai kuman dapat teridentifikasi melalui dischart</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Lakukan perawatan vulva</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Inkubasi kuman pada area genital yang relatif cepat dapat menyebabkan infeksi.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Terangkan pada klien cara mengidentifikasi tanda inveksi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Berbagai manivestasi klinik dapat menjadi tanda nonspesifik infeksi; demam dan peningkatan rasa nyeri mungkin merupakan gejala infeksi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Anjurkan pada suami untuk tidak melakukan hubungan senggama se;ama masa perdarahan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Pengertian pada keluarga sangat penting artinya untuk kebaikan ibu; senggama dalam kondisi perdarahan dapat memperburuk kondisi system reproduksi ibu dan sekaligus meningkatkan resiko infeksi pada pasangan.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Ansietas<span> </span>b.d kurang pengetahuan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Tujuan :</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;">pengetahuan klien dan keluarga terhadap penyakit meningkat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Kriteria hasil :</u></div><ol start="1" style="margin-top: 0cm;" type="a"><li class="MsoNormal" style="line-height: 150%; text-align: justify;">Tidak terjadi kecemasan</li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;">Menunjukan strategi koping efektif/keterampilan pemecahan masalah</li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><u>Rencana keperawatan :</u></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kaji tingkat pengetahuan/persepsi klien dan keluarga terhadap penyakit<br />
Rasional : Ketidaktahuan dapat menjadi dasar peningkatan rasa cemas</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Kaji derajat kecemasan yang dialami klien</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Kecemasan yang tinggi dapat menyebabkan penurunan penialaian objektif klien tentang penyakit</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Bantu klien mengidentifikasi penyebab kecemasan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Pelibatan klien secara aktif dalam tindakan keperawatan merupakan support yang mungkin berguna bagi klien dan meningkatkan kesadaran diri klien</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Asistensi klien menentukan tujuan perawatan bersama</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;">Rasional : Peningkatan nilai objektif terhadap masalah berkontibusi menurunkan kecemasan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span>Terangkan hal-hal seputar aborsi yang perlu diketahui oleh klien dan keluarga<br />
Rasional : Konseling bagi klien sangat diperlukan bagi klien untuk meningkatkan pengetahuan dan membangun support system keluarga; untuk mengurangi kecemasan klien dan keluarga.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><cite><b><span lang="FI" style="font-size: 14pt; font-style: normal; line-height: 150%;">DAFTAR PUSTAKA</span></b></cite><b><i><span style="font-size: 14pt; line-height: 150%;"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Bickley Lynn S.2008.Pemeriksaan Fisik Dan Riwayat Kesehatan Bates,Edisi 5. Penerbit Buku Kedokteran EGC. Jakarta</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Bobak, Lowdermilk, Jensen. (2004). Buku Ajar Keperawatan Maternitas. Edisi 4. Penerbit Buku Kedokteran EGC.Jakarta</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span lang="FI">Carpenito, Lynda, (2001), Buku Saku Diagnosa Keperawatan,Penerbit Buku Kedokteran EGC, Jakarta </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Doengoes, M. (2001). Rencana Perawatan Maternal / Bayi. Edisi 2. Penerbit Buku Kedokteran EGC.jakarta</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Hinchliff Sue.1999.Kamus Keperawatan,Edisi 17. Penerbit Buku Kedokteran EGC.Jakarta</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Mansjoer, Arif, dkk. 2001. Kapita Selekta Kedokteran, Jilid I. Media Aesculapius. Jakarta</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Mitayani.2009.Asuhan Keperawatan Maternitas,Salemba Medika.padang</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Muttaqin Arif. 2010.Pengkajian Keperawatan,Salemba Medika.Jakarta</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Price sylvia A,wilson lorraine M.2006.Konsep Klinis Proses-proses Penyakit,Edisi 6. Penerbit Buku Kedokteran EGC. Jakarta</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;">Sumapraja, Witjaksono. (2007). Majalah Kesehatan Keluarga “Dokter Kita”. Jakarta : Dian Rakyat.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Wiknjosastro Hanifa,dkk.2007.Ilmu Kebidanan. Edisi 9.Jakarta</div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com2tag:blogger.com,1999:blog-2695819362399801347.post-32764691554799076282011-02-22T17:25:00.000-08:002011-02-22T17:25:38.370-08:00Askep Hipertensi pada Kehamilan<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div class="MsoListParagraph" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>A<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">DEFINISI</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 14.2pt;">Hingga saat ini hipertensi dalam kehamilan masih merupakan salah satu penyebab morbiditas dan mortalitas pada ibu dan janinnva<span lang="IN">. </span><span style="font-family: "Times New Roman","serif";">Hipertensi dalam kehamilan berarti tekanan darah meninggi saat hamil. Keadaan ini biasanya mulai pada trimester ketiga, atau tiga bulan terakhir kehamilan. Kadang-kadang timbul lebih awal, tetapi hal ini jarang terjadi. Dikatakan tekanan darah tinggi dalam kehamilan jika tekanan darah sebelum hamil (saat periksa hamil) lebih tinggi dibandingkan tekanan darah di saat hamil.</span><span lang="IN" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>B<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif";">TERMINOLOGI</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Terminologi yang dapat dipakai adalah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 35.45pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif";">Hipertensi dalam kehamilan, atau</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 35.45pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif";">Preeklampsia-eklampsia</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>C<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">ETIOLOGI</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif";">Penyebab Hipertensi dalam kehamilan hingga kini belum diketahui dengan jelas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>D<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">KLASIFIKASI</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif";">Klasifikasi yang dipakai di Indonesia berdasarkan Report of the National High Blood Pressure Edukation Program Working Group on High Blood Pressure in Pregnancy tahun 2001 ialah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Hipertensi kronik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Hipertensi kronik adalah hipertensi yang timbul se</span><span lang="IN" style="font-family: "Times New Roman","serif";">b</span><span style="font-family: "Times New Roman","serif";">elum umur kehamilan 20 minggu atau hipertensi yang pertama kali didiagnosis setelah umur kehamilan 20 minggu dan hipertensi menetap sampai 12 minggu pascapersalinan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Preeklampsia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Preeklampsia adalah hipertensi yang timbul setelah 20 minggu kehamilan disertai dengan proteinuria.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Eklampsia </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;">Eklampsia adalah apabila ditemukan kejang-kejang pada penderita preeklampsia, yang juga dapat disertai koma<span lang="IN" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Hipertensi kronik dengan superimposed preeklampsia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Hipertensi kronik dengan superimposed pree</span><span lang="IN" style="font-family: "Times New Roman","serif";">k</span><span style="font-family: "Times New Roman","serif";">lampsia adalah hipertensi kronik disertai tanda-tanda pree</span><span lang="IN" style="font-family: "Times New Roman","serif";">k</span><span style="font-family: "Times New Roman","serif";">lampsia atau hipertensi kronik disertai proteinuria.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>5<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Hipertensi gestasional</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Hipertensi gestasional adalah hipetensi yang timbul pada kehamilan tanpa disertai proteinuria dan hipertensi menghilang setelah 3 bulan pascapersalinan atau kehamilan dengan tanda-tanda pree</span><span lang="IN" style="font-family: "Times New Roman","serif";">k</span><span style="font-family: "Times New Roman","serif";">lampsia tetapi tanpa proteinuria.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>E<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">FAKTOR RISIKO</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif";">Terdapat banyak faktor risiko untuk terjadinya hipertensi dalam kehamilan, yang dapat dikelompokkan dalam faktor risiko sebagai berikut.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Primigravida</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Hiperplasentosis, misalnya : mola hidatidosa, kehamilan multiple, diabetes mellitus, hisdrops fetalis, bayi besar</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Umur yang ekstrim</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Riwayat keluarga pernah pree</span><span lang="IN" style="font-family: "Times New Roman","serif";">k</span><span style="font-family: "Times New Roman","serif";">lampsia/eklampsia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Penyakitpenyakit ginjal dan hiperensi ya</span><span lang="IN" style="font-family: "Times New Roman","serif";">n</span><span style="font-family: "Times New Roman","serif";">g sudah ada sebe</span><span lang="IN" style="font-family: "Times New Roman","serif";">l</span><span style="font-family: "Times New Roman","serif";">um hamil</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Obesitas</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>F<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">PATOFISIOLOG</span><span lang="IN" style="font-family: "Times New Roman","serif";">I</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif";">Penyebab Hipertensi dalam kehamilan hingga kini belum diketahui dengan jelas. Banyak teori telah dikemukakan tentang terjadinya hipertensi dalam kehamilan, tetapi tidak ada satupun teori tersebut yang dianggap mutlak ben</span><span lang="IN" style="font-family: "Times New Roman","serif";">a</span><span style="font-family: "Times New Roman","serif";">r. Teori-teori yang sekarang banyak dianut adalah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Teori kelainan vaskularisasi plasenta</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Pada hipertensi dalam kehamilan tidak terjadi invasi sel-sel trofoblas pada sel-sel trofoblas pada lapisan otot arteri spiralis dan jaringan matriks sekitarnya. Lapisan otot arteri spiralis menjadi tetap kaku dan keras sehingga lumen arteri spiralis tidak memungkinkan mengalami distensi dan vasodilatasi. Akibatnya, arteri spiralis relative mengalami vasokontriksi, dan terjadi kegagalan “remodeling arteri spiralis”, sehingga aliran darah uteroplasenta menurun, dan terjadilah hipoksia dan iskemia plasenta. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Teori iskemia plasenta, radikal bebas, dan disfungsi endotel</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Iskemia plasenta dan pembentukan oksidan/radikal bebas</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif";">Sebagaimana dijelaskan pada teori invasi trofoblas, pada hipertensi dalam kehamil</span><span lang="IN" style="font-family: "Times New Roman","serif";">a</span><span style="font-family: "Times New Roman","serif";">n terjadi kegagalan “remodeling arteri spiralis”, dengan akibat plasenta mengalami iskemia. Plasenta yang mengalami iskemia dan hipoksia akan menghasilkan oksidan (disebut juga radikal bebas). Oksidan atau radikal bebas adalah senyawa penerima electron atau atom/molekul yang mempunyai electron yang tidak berpasangan. Salah satu oksidan penting yang dihasilkan plasenta iskemia adalah radikal hidroksil yang sangat toksis, khususnya<span> </span>terhadap membra</span><span lang="IN" style="font-family: "Times New Roman","serif";">n</span><span style="font-family: "Times New Roman","serif";"> sel endotel pembuluh darah. Sebenarnya produksi<span> </span>oksidan pada manusia adalah suatu proses normal, karena oksidan memang dibutuhkan untuk perlindungan tubuh. Adanya radikal hidroksil dalam darah, maka dulu hipertensi dalam kehamian disebut “toxaemia”. Radikal hidroksil akan merusak membrane sel, yang mengandung banyak asam lemak tidak jenuh menjadi peroksida lemak. Peroksida lemak selain akan merusak membrane sel, juga akan merusak nucleus, dan protein sel endotel. Produksi oksidan (radikal bebas) dalam tubuh yang bersifat toksis, selalu diimbangi dengan produksi anti oksidan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span>Peroksida lemak sebagai oksidan pada hipertensi dalam kehamilan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif";">Pada hipertensi dalam kehamilan telah terbukti bahwa kadar oksidan, khususnya peroksida lemak meningkat, sedangkan antioksidan, missal vitamin E pada hipertensi dalam kehamilan menurun, sehingga terjadi dominasi kadar oksidan peroksida lem</span><span lang="IN" style="font-family: "Times New Roman","serif";">a</span><span style="font-family: "Times New Roman","serif";">k yang relative tinggi. Perksidan lemak sebagai oksidan/radikal bebas yang sangat toksis ini akan beredar diseuruh tubuh daam aliran darah dan akan merusak membran sel endotel. Membran sel endotel lebih mudah mengalami kerusakan oleh peroksida lemak, karena letaknya langsung berhubungan dengan aliran darah dan mengandung banyak asam lemak tidak jenuh. Asam lemak tidak jenuh sangat rentan terhadap oksidan radikal hidroksil, yan</span><span lang="IN" style="font-family: "Times New Roman","serif";">g</span><span style="font-family: "Times New Roman","serif";"> akan berubah menjadi peroksida lemak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Disfungsi sel endotel</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif";">Akibat sel endotel terpapar terhadap peroksida lemak, maka terjadi kerusakan sel endotel, yang kerusakannya dimulai dari membran sel endotel. Kerusakan membran sel endotel mengakibatkan terganggunya fungsi endotel, bahkan rusaknya</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">seluruh struktur sel endotel. Keadaan ini disebut disfungsi endotel.</span><span lang="IN" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Teori intoleransi imunologik antara ibu dan janin</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Pada<span> </span>plasenta hipertensi dalam kehamilan, terjadi penurunan ekspresi HLA-G. Berkurangnya HLA-G di desidua daerah plasenta, menghambat invasi trofoblas ke dalam desidua. Invasi trofoblas sangat penting agar jaringan desidua menjadi lunak, dan gembur sehingga memudahkan terjadinaya reaksi inflamasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Teori adaptasi kardiovaskular</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Pada hipertensi dalam kehamilan kehilangan daya refrakter terhadap bahan vasokonstriktor, dan ternyata terjadi peningkatan kepekaan terhadap bahan-bahan vasopresor. Artinya daya refrakter pembuluh darah terhadap bahan vasopresor hilang sehinggapembuluh darah menjadi sangat peka terhadap bahan-bahan vasopresor pada hipert ensi dalam kehamilan sudah terjadi pada trimester I (pertama). Peningkatan kepekaan pada kehamilan<span> </span>yang akan menjadi hipertensi dalam kehamilan, sudah dapat ditemukan pada kehamilan dua puluh minggu. Fakta ini dapat dipakai sebagai prediksi akan terjadinya hipertensi dalam kehamilan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Teori defisiensi gizi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Beberapa hasil penelitian menunjukkan bahwa kekurangan defisiensi gizi berperan dalam terjadinya hipertensi dalam kehamilan. Penelitian yang penting yang pernah dilakukan di inggris ialah penelitian tentang pengaruh diet pada preeklampsia<span> </span>beberapa waktu sebelum pecahnya Perang Dunia ke II. Suasana serba sulit mendapat gizi yang cukup dalam persiapan perang menimbulkan kenaikan insiden hipertensi dalam kehamilan. Penelitian terakhir membuktikan bahwa konsumsi minyak ikan, termaksud minyak hati halibut dapat men</span><span lang="IN" style="font-family: "Times New Roman","serif";">g</span><span style="font-family: "Times New Roman","serif";">urangi risiko preeclampsia.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Teori inflamasi</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif";">Teori ini berdasarkan fakta bahwa lepasnya debris trofoblas di dalam sirkulasi darah merupakan rangsangan utama terjadinya proses inflamasi. Pada kehamilan normal, jumlah debris trofoblas masih dalam batas wajar, sehingga reaksi inflamasi juga msih dalam batas normal. Berbeda dengan proses apoptosis pada preeklampsia, dimana ada preeklampsia terjadi peningkatan stresoksidatif, sehingga produksi debris apoptosis dan nekrotik trofoblas juga meningkat. Makin banyak sel trofoblas plasenta, misalnya pada plasenta besar, pada hamil ganda, maka reaksi stress oksidatif kan sangat meningkat, sehingga jumlah sisa debris trofobls juga makin meningkat. Keadaan ini menimbulkan beban reaksi inflamasi dalam darah ibu menjadi juh lebih besar, dibanding reaksi inflamsi pada kehamilan normal. Respons inflamasi ini akan mengaktifasi sel endotel, dan sel-sel makrofag/granulosit, yang lebih besar pula, sehingga terjadi reaksi sistemik inflamasi yang menimbulkan gejala-gejala pada preeklampsia pada ibu</span><span lang="IN" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>G<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">PENATALAKSANAAN</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Adapun penatalaksanaannya antara lain :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Deteksi Prenatal Dini</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Waktu pemeriksaan pranatal dijadwalkan setiap 4 minggu sampai usia kehamilan 28 minggu, kemudian setiap 2 minggu hingga usia kehamilan 36 minggu, setelah itu setiap minggu.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Penatalaksanaan<span> </span>Di Rumah Sakit</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Evaluasi sistematik yang dilakukan mencakup :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pemeriksaan terinci diikuti oleh pemantauan setiap hari untuk mencari temuan-temuan klinis seperti nyeri kepala, gangguan penglihatan, nyeri epigastrium, dan pertambahan berat yang pesat.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Berat badan saat masuk</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Analisis untuk proteinuria saat masuk dan kemudian paling tidak setiap 2 hari</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pengukuran tekanan darah dalam posisi duduk setiap 4 jam kecuali antara tengah malam dan pagi hari</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pengukuran kreatinin plasma atau serum, gematokrit, trombosit, dan enzim hati dalam serum, dan frekuensi yang ditentukan oleh keparahan hipertensi</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Evaluasi terhadap ukuran janin dan volume cairan amnion baik secara klinis maupun USG</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Wingdings;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Terminasi kehamilan</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pada hipertensi sedang atau berat yang tidak membaik setelah rawat inap biasanya dianjurkan pelahiran janin demi kesejahteraan ibu dan janin. Persalinan sebaiknya diinduksi dengan oksitosin intravena. Apabila tampaknya induksi persalinan hampir pasti gagal atau upaya induksi gagal, diindikasikan seksio sesaria untuk kasus-kasus yang lebih parah.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Terapi Obat Antihipertens</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pemakaian obat antihipertensi sebagai upaya memperlama kehamilan atau memodifikasi prognosis perinatal pada kehamilan dengan penyulit hipertensi dalam berbagai tipe dan keparahan telah lama menjadi perhatian.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Penundaan Pelahiran Pada Hipertensi Berat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Wanita dengan hiperetensi berat biasanya harus segera menjalani pelahiran. Pada tahun-tahun terakhir, berbagai penelitian diseluruh dunia menganjurkan pendekatan yang berbeda dalam penatalaksanaan wanita dengan hiperetensi berat yang jauh dari aterm. Pendekatan ini menganjurkan penatalaksanaan konservatif atau “menunggu” terhadap kelompok tertentu wanita dengan tujuan memperbaiki prognosis janin tanpa mengurangi keselamatan ibu.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 18pt;"><b><span style="font-family: "Times New Roman","serif";">ASUHAN KEPERAWATAN PADA HIPERTENSI DALAM KEHAMILAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">PENGKAJIAN</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif";">Pengumpulan Data</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif";">Data-data yang perlu dikaji adalah berupa</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Identitas klien</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Keluhan Utama</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Pasien dengan hipertensi pada kehamilan didapatkan keluhan berupa seperti sakit kepala terutama area kuduk bahkan mata dapat berkunang-kunang, pandangan mata kabur, proteinuria (protein dalam urin), peka terhadap cahaya, nyeri ulu hati.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Riwayat Penyakit Sekarang</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Pada pasien jantung hipertensi dalam kehamilan, biasanya akan diawali dengan tanda-tanda mudah letih, nyeri kepala (tidak hilang dengan analgesik biasa ), diplopia, nyeri abdomen atas (epigastrium), oliguria (<400 ml/ 24 jam)serta nokturia dan sebagainya. Perlu juga ditanyakan apakah klien menderita diabetes, penyakit ginjal, rheumatoid arthritis, lupus atau skleroderma, perlu ditanyakan juga mulai kapan keluhan itu muncul. Apa tindakan yang telah dilakukan untuk menurunkan atau menghilangkan keluhan-keluhan tersebut</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Riwayat Penyakit Dahulu</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Perlu ditanyakan apakah pasien pernah menderita penyakit seperti kronis hipertensi (tekanan darah tinggi sebelum hamil), Obesitas, ansietas, angina, dispnea, ortopnea, hematuria, nokturia dan sebagainya. Ibu beresiko dua kali lebih besar bila hamil dari pasangan yang sebelumnya menjadi bapak dari satu kehamilan yang menderita penyakit ini. Pasangan suami baru mengembalikan resiko ibu sama seperti primigravida. Hal ini diperlukan untuk mengetahui kemungkinan adanya faktor predisposisi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Riwayat Penyakit Keluarga</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Perlu ditanyakan apakah ada anggota keluarga yang menderita penyakit-penyakit yang disinyalir sebagai penyebab jantung hipertensi dalam kehamilannya. Ada hubungan genetik yang telah diteliti. Riwayat keluarga ibu atau saudara perempuan meningkatkan resiko empat sampai delapan kali</span><span lang="IN" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Riwayat Psikososial</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Meliputi perasaan pasien terhadap penyakitnya, bagaimana cara mengatasinya serta bagaimana perilaku pasien terhadap tindakan yang dilakukan terhadap dirinya</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pengkajian Sistem Tubuh</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><strong>B1 (Breathing)</strong></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Pernafasan meliputi sesak nafas sehabis aktifitas, batuk dengan atau tanpa sputum, riwayat merokok, penggunaan obat bantu pernafasan, bunyi nafas tambahan, sianosis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><strong>B2 (</strong><em><b>Blood)</b></em></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Gangguan fungsi kardiovaskular pada dasarnya berkaitan dengan meningkatnya afterload jantung akibat hipertensi. Selain itu terdapat perubahan hemodinamik, perubahan volume darah berupa hemokonsentrasi. Pembekuan darah terganggu waktu trombin menjadi memanjang. Yang paling khas adalah trombositopenia dan gangguan faktor pembekuan lain seperti menurunnya kadar antitrombin III. Sirkulasi meliputi adanya riwayat hipertensi, penyakit jantung coroner, episodepalpitasi, kenaikan tekanan darah, takhicardi, kadang bunyi jantung terdengar S2 pada dasar , S3 dan S4, kenaikan TD, nadi denyutan jelas dari karotis, jugularis, radialis, takikardi, murmur stenosis valvular, distensi vena jugularis, kulit pucat, sianosis, suhu dingin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><strong>B3 (</strong><em><b>Brain)</b></em></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Lesi ini sering karena pecahnya pembuluh darah otak akibat hipertensi. Kelainan radiologis otak dapat diperlihatkan dengan CT-Scan atau MRI. Otak dapat mengalami edema vasogenik dan hipoperfusi. Pemeriksaan EEG juga memperlihatkan adanya kelainan EEG terutama setelah kejang yang dapat bertahan dalam jangka waktu seminggu.Integritas ego meliputi cemas, depresi, euphoria, mudah marah, otot muka tegang, gelisah, pernafasan menghela, peningkatan pola bicara. Neurosensori meliputi keluhan kepala pusing, berdenyut , sakit kepala sub oksipital, kelemahan pada salah satu sisi tubuh, gangguan penglihatan (diplopia, pandangan kabur), epitaksis, kenaikan terkanan pada pembuluh darah cerebral</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><strong>B4 (</strong><em><b>Bladder</b></em><strong>)</strong></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Riwayat penyakit ginjal dan diabetes mellitus, riwayat penggunaan obat diuretic juga perlu dikaji. Seperti pada glomerulopati lainnya terdapat peningkatan permeabilitas terhadap sebagian besar protein dengan berat molekul tinggi. Sebagian besar penelitian biopsy ginjal menunjukkan pembengkakan endotel kapiler glomerulus yang disebut endoteliosis kapiler glomerulus. Nekrosis hemoragik periporta dibagian perifer lobulus hepar kemungkinan besar merupakan penyebab meningkatnya kadar enzim hati dalam serum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><strong>B5 (</strong><em><b>Bowel)</b></em></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Makanan/cairan meliputi makanan yang disukai terutama yang mengandung tinggi garam, protein, tinggi lemak, dan kolesterol, mual, muntah, perubahan berat badan, adanya edema.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><strong>B6 </strong><em><b>(Bone)</b></em></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><span style="font-family: "Times New Roman","serif";">Nyeri/ketidaknyamanan meliputi nyeri hilang timbul pada tungkai,sakit kepala sub oksipital berat, nyeri abdomen, nyeri dada, nyeri ulu hati. Keamanan meliputi gangguan cara berjalan, parestesia, hipotensi postural</span><span lang="IN" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 40.5pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">DIAGNOSA</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif";">Diagnosa keperawatan ditegakkan melalui analisis cermat terhadap hasil pengkajian. Diagnosa keperawatan yang umum untuk orang tua dengan gangguan hipertensi pada kehamilan meliputi hal-hal berikut:</span></div><ol start="1" style="color: #d9ead3;" type="1"><li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif";">Perubahan perfusi jaringan/organ, menurun, b.d<span> </span>hipertensi</span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif";">Resiko cedera tinggi pada ibu b.d. iritabilitas SSP</span><span style="font-family: "Times New Roman","serif";"></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif";">Kecemasan berhubungan dengan ancaman cedera pada bayi sebelum lahir</span><span style="font-family: "Times New Roman","serif";"></span></li>
</ol><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">INTERVENSI</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Perubahan perfusi jaringan b.d. Hipertensi, Vasospasme siklik, Edema serebral, Perdarahan</span></div><div class="MsoNormal" style="color: #d9ead3; line-height: normal; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tujuan : tidak terjadi vasospasme dan perfusi jaringan tidak terjadi</span></div><div class="MsoNormal" style="color: #d9ead3; line-height: normal; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kriteria hasil : klien akan mengalami vasodilatasi ditandai dengan diuresis, penurunan tekanan darah, edema</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Memantau asupan oral dan ifus IV MGSO<sub>4</sub></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt;"><span style="font-family: "Times New Roman","serif";">R : MGSO<sub>4</sub> adalah obat anti kejang yang bekerja pada sambungan mioneural dan merelaksasi vasospasme sehingga menyebabkan peningkatan perfusi ginjal, mobilisasi cairan ekstra seluler (edema dan dieresis)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Memantau urin yang kluar</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">R : mengetahui jumlah urin yang keluar </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Memantau edema yang terlihat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">R : </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Mempertahankan tirah baring total dengan posisi miring</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt;"><span style="font-family: "Times New Roman","serif";">R : Tirah baring menyebabkan aliran darah urtero plasenta, yang sering kali menurunkan tekanan darah dan meningkatkan dieresis</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Resiko cedera tinggi pada ibu b.d. iritabilitas SSP</span></div><div class="MsoNormal" style="color: #d9ead3; line-height: normal; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tujuan : gangguan SSP akan menurun mencapai tingkat normal</span></div><div class="MsoNormal" style="color: #d9ead3; line-height: normal; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kriteria hasil : klien tidak mengalami kejang</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Mendapatkan data-data dasar (misal DTRs,klonus)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt;"><span style="font-family: "Times New Roman","serif";">R : data-data dasar dugunakan untuk memantau hasil terapi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Memantau pemberian IV MgSO<sub>4</sub> dan kadar serum MgSO<sub>4</sub></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt;"><span style="font-family: "Times New Roman","serif";">R : MGSO<sub>4</sub> adalah obat anti kejang yang bekerja pada sambungan mioneural dan merelaksasi vasospasme</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">mengkaji adanya kemungkinan<sub> </sub>keracunan MgSO<sub>4</sub></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt;"><span style="font-family: "Times New Roman","serif";">R : Dosis yang berlebih akan membuat kerja otot menurun sehingga dapat menyebabkan depresi pernapasan berat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">mempertahankan lingkungan yang tenang, gelap dan nyaman</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt;"><span style="font-family: "Times New Roman","serif";">R : Rangsangan kuat, misalnya cahaya terang dan suara keras dapat menimbulkan kejang</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-indent: -18pt;"><span style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Kecemasan berhubungan dengan ancaman cedera pada bayi sebelum lahir</span></div><div class="MsoNormal" style="color: #d9ead3; line-height: normal; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tujuan: ansietas dapat teratasi</span></div><div class="MsoNormal" style="color: #d9ead3; line-height: normal; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kriteria hasil:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; line-height: normal; margin: 0cm 0cm 0.0001pt 54pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span>Tampak rileks, dapat istirahat dengan tepat </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Menuujukkan ketrampilan pemecahan masalah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Kaji tingkat ansietas pasien. Perhatikan tanda depresi dan pengingkaran</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif";">R : Membantu menentukan jenis intervensi yang diperlukan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Dorong dan berikan kesempatan untuk pasien atau orang terdekat mengajukan pertanyaan dan menyatakan masalah</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif";">R : Membuat perasaan terbuka dan bekerja sama untuk memberikan informasi yang akan membantu mengatasi masalah</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Dorong orang terdekat berpartisipasi dalam asuhan, sesuai indikasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif";">R : Keterlibatan meningkatka perasaan berbagi, manguatkan perasaan berguna, memberikan kesempatan untuk mengakui kamampuan individu dan memperkecil rasa takut karena ketidaktahuan.</span></div><div class="MsoNormal" style="color: #d9ead3;"><br />
</div><div align="center" class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 0cm; text-align: center;"><span style="font-family: "Times New Roman","serif";">DAFTAR PUSTAKA</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 18pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://checool.blogspot.com/"><span lang="IN">http://checool.blogspot.com</span></a></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (Diakses 11 </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">J</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">uli 2010)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://hidayat2.wordpress.com/"><span lang="IN">http://hidayat2.wordpress.com</span></a></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (Diakses </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11 Juni</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> 20</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">10</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://infokedoketran.com/"><span lang="IN">http://infokedoketran.com</span></a></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (Diakses </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11 Juni</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> 20</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">10</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://kumpulan-asuhan-keperawatan.blogspot.com/"><span lang="IN">http://kumpulan-asuhan-keperawatan.blogspot.com</span></a></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (Diakses </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11 Juni 2010</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://reproduksiumj.blogspot.com/"><span lang="IN">http://reproduksiumj.blogspot.com</span></a></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (Diakses </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11 Juni 2010</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span lang="IN">)</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://viethanurse.wordpres.com/"><span lang="IN">http://viethanurse.wordpres.com</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span lang="IN">(Dikses </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11 Juni 2010</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://www.balipost.co.id/"><span lang="IN">http://www.balipost.co.id</span></a></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (Diakses </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11 Juni 2010</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://www.wartamedika.com/"><span lang="IN">http://www.wartamedika.com</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span lang="IN">(Diakses </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11 Juni 2010</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mansjoer, Kuspuji. dkk. 2001. <i>Kapita Selekta Kedokteran</i>. Edisi Ketiga: Jilid 1. Jakarta: Media Aesculapius.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Wiknjosastro, Hanifa. 2008. <i>Ilmu Kebidanan</i>. Edisi Ketiga : Cetakan Ketujuh. Jakarta : Yayasan Bina Pustaka Sarwono Prawirohardjo.</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com3tag:blogger.com,1999:blog-2695819362399801347.post-17483089444620241062011-02-22T17:18:00.000-08:002011-02-22T17:18:05.977-08:00Askep Hamil Kembar<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: #d9ead3; text-align: center;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: #d9ead3; text-align: center;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 16pt; line-height: 115%;">PEMBAHASAN</span></b></div><div align="center" class="MsoNormal" style="color: #d9ead3; text-align: center;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;">LANDASAN TEORI</span></u></b></div><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">A. DEFINISI</span></u></b></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><br />
<span> </span><span> </span>Kehamilan ganda atau kehamilan kembar adalah kehamilan dengan dua janin atau lebih.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kehamilan kembar terjadi bila 2 atau lebih ovum mengalami pembuahan ( <b><i>dizygotic</i></b>) atau bila satu ovum yang sudah dibuahi mengalami pembelahan terlalu dini sehingga membentuk 2 embrio yang identik (<b><i>monozygotic</i></b>).</span><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></b></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Kembar monozygotik terjadi pada 2.3 – 4 per 1000 kehamilan pada semua jenis suku bangsa, 30% dari semua jenis kehamilan kembar.Kembar dizygotic (<i>fraternal</i>) adalah dua buah ovum yang mengalami pembuahan secara terpisah, 70% dari semua jenis kehamilan kembar.</span></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Sejak ditemukannya obat-obat dan cara induksi ovulasi maka dari laporan-laporan dari seluruh pelosok dunia, frekuensi kehamilan kembar condong meningkat. Bahkan sekarang telah ada hamil kembar lebih dari 6 janin</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">.15 tahun terakhir ini angka kejadian kehamilan kembar meningkat oleh karena :</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pemakaian luas dari obat induksi ovulasi</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Penerapan ART (<i>assisted reproductive technology</i>)</span></div><div class="MsoNormal" style="color: #d9ead3;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Morbiditas dan mortalitas maternal lebih tinggi pada kehamilan kembar dibanding kehamilan tunggal akibat :</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Persalinan preterm</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Perdarahan</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Infeksi traktus urinarius</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Hipertensi dalam kehamilan</span></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">2/3 kehamilan kembar berakhir dengan persalinan janin tunggal (sebagian embrio lain berakhir dalam usia kehamilan 10 minggu).Mortalitas perinatal kehamilan kembar terutama terjadi pada kehamilan kembar monozygotik lebih tinggi dari kehamilan tunggal oleh karena :</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kelainan kromosome</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Prematuritas</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kelainan kongenital</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Hipoksia</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 36pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Trauma </span></div><div class="MsoNormal" style="color: #d9ead3;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><br />
<b><u>B. ETIOLOGI</u></b></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Faktor-faktor yang mempengaruhi adalah: bangs4 umur dan paritas, sering mempengaruhi kehamilan kembar 2 telur.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Factor obat-obat konduksi ovulasi: profertil, clomid, dan hormone gonadotropin dapat menyebabkan kehamilan dizigotik dan kembar lebih dari 2.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Factor keturunan.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Factor yang lain belum diketahui. </span></div><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">C.PATOGENESIS</span></u></b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><ol start="1" style="color: #d9ead3;" type="1"><li class="MsoNormal"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kehamilan kembar MONOZYGOTIK</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></li>
</ol><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kehamilan kembar yang terjadi dari fertilisasi sebuah ovum dari satu sperma.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Biasanya memiliki jenis kelamin sama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Perkembangan tergantung pada saat kapan terjadinya divisi preimplantasi</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Umumnya memiliki karakteristik fisik sama ( bayangan cermin) ; namun dengan sidik jari yang berbeda.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 18pt;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">2.Kehamilan kembar DIZYGOTIK</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kehamilan kembar yang berasal dari dua buah ovum dan dua sperma.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kehamilan kembar dizyogitic dapat memiliki jenis sex berbeda atau sama.Faktor yang mempengaruhi terjadinya kembar dizygotic :</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Ras (lebih sering pada kulit berwarna)</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Angka kejadian di Jepang 1.3 : 1000 ; di Nigeria 49 : 1000 dan di USA 12 : 1000</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Cenderung berulang.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Menurun dalam keluarga (terutama keluarga ibu).</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Usia (sering terjadi pada usia 35 – 45 tahun).</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Ukuran tubuh ibu besar sering mempunyai anak kembar.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Golongan darah O dan A sering mempunyai anak kembar.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Sering terjadi pada kasus yang segera hamil setelah menghentikan oral kontrasepsi.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Penggunaan klomifen sitrat meningkatkan kejadian kehamilan kembar monozygotic sebesar 5 – 10% .</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 18pt;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">3.Bentuk kehamilan kembar lain</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Fertilisasi 2 ovum yang berasal dari 1 oosit dengan 2 sperma.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Fertilisasi satu ovum dengan 2 sperma pada dua kejadian coitus yang berbeda (<b><i>superfecundasi</i></b>)</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Superfetation</span></i></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"> adalah fertilisasi 2 ovum yang dilepaskan pada dua haid yang berbeda (tidak mungkin terjadi pada manusia) oleh karena corpus luteum pada proses kehamilan sebelumnya akan menekan terjadinya proses ovulasi pada siklus bulan berikutnya.</span></div><div class="MsoNormal" style="color: #d9ead3; text-indent: 36pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Frekuensi menurut hukum Hellin antara kehamilan ganda dan tunggal adalah:</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 108pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 14pt; line-height: 115%;"><span><img alt="*" height="16" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="16" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Gemelly (2) 1:8</span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 108pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 14pt; line-height: 115%;"><span><img alt="*" height="16" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="16" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Triplet (3) 1:89²</span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 108pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 14pt; line-height: 115%;"><span><img alt="*" height="16" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="16" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Quadruplet (4) 1:89³</span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 108pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 14pt; line-height: 115%;"><span><img alt="*" height="16" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="16" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Quintuplet (5) 1:89</span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 0cm; text-indent: 90pt;"><span lang="IN" style="font-family: Symbol; font-size: 14pt; line-height: 115%;"><span><img alt="*" height="16" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="16" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Sextuplet (6) 1:89<br />
<u><br />
<b>C.JENIS GEMELLI</b></u></span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 90pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Gemelli dizigotik</span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">(kembar 2 telur), heterolog, biovuler dan futernal, kedua telur bisa berasal dari :<br />
a) 1 ovarium dan dari 2 folikel de graft<br />
b) 1 ovarium dan dari 1 folikel de graft<br />
c) 1 ovarium kanan dan satu lagi dari ovarium kiri</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><i>Gemelli monozigotik</i> (kembar I telur), homotog, uniovuler, identik dapat terjadi karena:<br />
a) Satu telur dengan 2 inti, hambatan pada tingkat blastula<br />
b) Hambatan setelah amnion dibentuk, tetapi sebelum primitive steak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Coryoined fwins</span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">, super fekundasi dan superficial<br />
<i><span> </span><span> </span>conjoined twins</i> atau kembar siam adalah kembar dimana janin melengket<br />
satu dengan yang lainnya. Misalnya torakopagus (dada dengan dada), abdominopagus (perlengketan kedua abdomen), kraniopagus (kedua kepala) dan sebagainya. </span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Superfukundasi adalah pembuahan dua telur yang dikeluarkan pada ovulasi yang sama pada dua kali koiytus yang dilakukan pada jarak waktu yang pendek. Hal ini dilaporkan oleh Archer (1990) seorang wanita kulit putih yang melakukan koitus berturut-turut dengan seorang kulit putih dan kemudian dengan pria Negro melahirkan bayi kembar : satu bayi putih dan satu bayi Negro (mulatto).Superfetasi adalah kehamilan kedua yang terjadi beberapa minggu atau bulan setelah kehamilan pertama. Belum pernah dibuktikan pada manusia namun dapat ditemukan pada kuda.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 18pt;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">D.PERTUMBUHAN JANIN KEMBAR</span></u></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 56.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">berat badan satu janin kehamilan kembar rata-rata 1000gr lebih ringan<br />
dari janin tunggal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 56.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">berat badan baru lahir biasanya pada kembar dua di bawah 2500 gr, triplet<br />
di bawah 2000 gr, quadriplet di bawah 1500 gr dan quintuplet di bawah I 000 gr.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 56.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">berat badan masing-masin janin dari kehamilan kembar tidak sama umumnya<br />
berselisih antara 50 sampai 1000gr, karena pembagian sirkulasi darah tidak sama maka yang satu kurang bertumbuh dari yang lainnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 56.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">pada kehamilan ganda monozigotik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 92.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pembuluh darah janin yang satu beranastomosis dengan janin yang<br />
lain, karena itu setelah bayi satu lahir tali pusat harus diikat untuk menghindari perdarahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 92.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Karena itu janin yang satu dapat terganggu pertumbuhannya dan menjadi<br />
monstrum seperti akardiakus dan kelainan lainnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 92.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Dapat terjadi sindroma transfuse fetal: pada janin yang dapat darah lebih banyak terjadi: hidramnion, polisitemia, edema dan pertumbuhan yang baik. Sedangkan janin kedua kurang pertumbuhan nya terjadilah: kecil, anemia, dehidrasi, oligohidramni dan mikrokardia.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 2cm; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">pada kehamilan kembar dizigotik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 94.85pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Dapat terjadi satu janin meninggal dan yang satu tumbuh sampai cukup bulan. </span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 94.85pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Janin yang mati bisa diresorbsi (kalau pada kehamilan muda) atau pada kehamilan agak tuajanin jadi gepeng disebut fetus papyraseus atau kompresus.</span></div><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">E.GEJALA KLINIK</span></u></b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><ol start="1" style="color: #d9ead3;" type="1"><ol start="1" type="1"><li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Keluhan kehamilan lebih sering terjadi dan lebih berat. </span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Tanda-tanda yang sering terlihat : </span></li>
</ol></ol><div class="MsoNormal" style="color: #d9ead3; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Ukuran uterus lebih besar dari yang diharapkan.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kenaikan berat badan ibu berlebihan.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Polihidramnion.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Riwayat ART (Assisted Reproductive Technology)</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kenaikan MSAFP (maternal serum alpha feto protein)</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Palpasi yang meraba banyak bagian kecil janin. </span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Detik Jantung Janin lebih dari 1 tempat dengan perbedaan frekuensi sebesar > 8 detik per menit.</span></div><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">F.LETAK PADA PRESENTASI LANIN</span></u></b></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><br />
</span></u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Pada kehamilan kembar sering terjadi kesalahan presentasi dan posisi kedua janin. Begitu pula letak janin kedua dapat berubah setelah janin pertama lahir, misalnya dari letak lintang berubah menjadi letak sungsang atau letak kepala. Berbagai kombinasi letak, presentasi dan posisi bisa terjadi ; yang paling sering dijumpai adalah:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 38.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kedua janin dalam letak membujur,presentasi kepala;( 44-47%) </span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Letak membujur,presentasi kepala bokong( 37-38%) </span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Keduanya presentasi bokong( 8-10%)</span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Letak lintang dan presentasi kepala( 5-5,3%) </span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Letak lintang dan presentasi bokong( 1,5-2%)</span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Dua-duanya letak lintang( 0,2-0,60/o)</span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 38.1pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Letak dan presentasi 69 adalah letak yang berbahaya, karena dapat terjadi<br />
"kunci-mengunci" (interlocking).</span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">G.</span></u></b><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">FAKTOR FAKTOR TERKAIT</span></u></b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><ol start="1" style="color: #d9ead3;" type="1"><li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Anemia gravidarum sering terjadi .</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Gangguan pada sistem respirasi dimana <b><i>“Respiratory tidal volume” </i></b>meningkat tapi pasien lebih bebas bernafas oleh karena kadar progesteron yang tinggi.</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kista lutein dan asites sering terjadi oleh karena tingginya hCG.</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Perubahan kehamilan lebih menyolok pada sistem kardiovaskular, sistem respirasi, sistem Gastrointestinal , ginjal dan sistem muskuloskeletal.</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Termasuk<b><i> kehamilan resiko tinggi</i></b> oleh karena meningkatnya kejadian :</span></li>
</ol><ul style="color: #d9ead3;" type="disc"><ul type="circle"><li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Anemia gravidarum</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Infeksi traktus urinariums</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Preeklampsia –eklampsia</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Perdarahan sebelum-selama dan sesudah persalinan</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kejadian plasenta previa </span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Inersia uteri</span></li>
</ul></ul><div class="MsoNormal" style="color: #d9ead3;"><span lang="IN"><a href="http://lh4.ggpht.com/_ezSsIEHCzdA/SqTTlrFpoxI/AAAAAAAAAgk/SyM4e-Cmmtg/s1600-h/Gemelli%5b3%5d.jpg"><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%; text-decoration: none;"> </span></a></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3; text-indent: 36pt;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">A. Plasenta dan talipusat</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Plasenta dan selaput ketuban pada kembar monozygote dapat bervariasi seperti terlihat pada gambar 22.1, tergantung pada saat “pembelahan awal” pada discus embrionik. Variasi yang dapat terlihat adalah :</span></div><div class="MsoNormal" style="color: #d9ead3; margin-bottom: 0.0001pt;"><span lang="IN"><a href="http://lh4.ggpht.com/_ezSsIEHCzdA/SqTTp9CcmFI/AAAAAAAAAgs/A_ibCe6CcaY/s1600-h/clip_image002%5b4%5d.jpg"><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%; text-decoration: none;"> </span></a></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3;"><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Selaput ketuban pada kehamilan kembar</span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><ol start="1" style="color: #d9ead3;" type="1"><li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pembelahan sebelum stadium morula dan diferensiasi trofoblas (pada hari ke III) menghasilkan 1 atau 2 plasenta, 2 chorion dan 2 amnion (sangat menyerupai kembar dizygotic dan meliputi hampir 1/3 kasus kembar monozygotic)</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pembelahan setelah diferensiasi trofoblas tapi sebelum pembentukan amnion (hari ke IV – VIII) menghasilkan 1 plasenta dan 2 amnion ( meliputi 2/3 kasus kembar monozygotic)</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pembelahan setelah diferensiasi amnion ( hari ke VIII – XIII) menghasilkan 1 plasenta, 1 chorion dan 1 amnion</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pembelahan setelah hari ke 15 menyebabkan kembar tak sempurna, pembelahan pada hari ke XIII – XV menyebabkan <i>kembar siam</i>.</span></li>
</ol><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Masalah paling serius pada plasenta monochorionic adalah jalur pintas pembuluh darah yang disebut sebagai sindroma <i>“twin to twin tranfusion”</i> yang terjadi akibat anastomosis masing-masing individu sejak kehamilan awal mereka.</span></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Komunikasi yang terjadi dapat ateri-arteri, vena-vena atau arteri – vena. Yang paling berbahaya adalah kombinasi arteri-vena yang dapat menyebabkan sindroma <i>“twin to twin tranfusion”</i></span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Janin resipien</span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"> akan mengalami : edematous, hipertensi, asites, ‘kern’ icterus, pembesaran ginjal dan jantung, hidramnion akibat poliuria, hipervolemia dan meninggal akibat gagal jantung dalam usia 24 jam pertama.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Janin donor</span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"> : kecil, pucat, dehidrasi akibat PJT-Pertumbuhan janin terhambat, malnutrisi dan hipovolemia, oligohidramnion, anemia berat, hidrops fetalis dan gagal jantung.</span></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify; text-indent: 18pt;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">B. Janin</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify; text-indent: 18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Melalui pemeriksaan ultrasonografi secara dini, diketahui bahwa angka kejadian kehamilan kembar sebelum kehamilan 12 minggu kira-kira 3.29 – 5.39%. Namun 20% diantaranya satu atau lebih janin akan menghilang secara spontan dan kadang-kadang disertai dengan perdarahan pervaginam yang merupakan kjadian abortus (<b><i>“vanishing twin”</i></b>).Kelainan kongenital pada kehamilan kembar ± 2% ( pada kehamilan tunggal ± 1%) Kelainan kongenital pada kembar monozygotic lebih sering.</span></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">H.PEMERIKSAAN KLINIS</span></u></b></div><ol start="1" style="color: #d9ead3;" type="1"><li class="MsoNormal"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Temuan Laboratorium</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></li>
</ol><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Sebagian besar kehamilan kembar terdeteksi atas dasar pemeriksaaan MSAFP dan atau ultrasonografi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kadar Hematokrit dan Hemoglobin menurun.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Anemia maternal : hipokromik normositik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kemungkinan terjadi gangguan pada pemeriksaan OGTT-oral glucosa tolerance test. </span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 72pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: #d9ead3; margin-left: 18pt;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">2.Pemeriksaan ultrasonografi</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pemeriksaan ultrasonografi pada kehamilan kembar harus dikerjakan. Pada kehamilan kembar dichorionic : jenis kelamin berbeda, plasenta terpisah dengan dinding pemisah yang tebal (> 2mm) atau “twin peak sign” dimana membran melekat pada dua buah plasenta yang menjadi satu.Pada kehamilan monochorionik tidak terlihat gambaran diatas.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Presentasi vertex-vertex = 50% kasus kehamilan kembar</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Presentasi vertex-bokong = 33% kasus kehamilan kembar</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 72pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Presentasi bokong-bokong = 10% kasus kehamilan kembar</span></div><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">I.DIAGNOSA BANDING</span></u></b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 38.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kehamilan tunggal</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kesalahan dalam penentuan tanggal HPHT-hari pertama haid terakhir dan Estimated Date of Confinement-EDC sering menyebabkan kesalahan diagnosa kehamilan kembar.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Polihidramnion </span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Mola Hidatidosa</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Tumor abdomen dalam kehamilan:</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 74.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Mioma uteri</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 74.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Tumor ovarium</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 74.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Vesika urinaria yang penuh<span> </span></span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kehamilan Kembar dengan komplikasi</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">J.KOMPLIKASI</span></u></b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><ul style="color: #d9ead3;" type="disc"><li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Hipertensi dalam kehamilan</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Anemia</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Polihidramnion</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Persalinan preterm</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Persalinan macet akibat <i>interlocking</i> atau <i>collision</i> bagian terendah janin</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Mortalitas perinatal meningkat</span></li>
</ul><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">K.PROGNOSIS</span></u></b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><ul style="color: #d9ead3;" type="disc"><li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Mortalitas maternal tidak jauh berbeda dengan kehamilan tunggal.</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Riwayat persalinan dengan kembar dizygotic meningkatkan kemungkinan persalinan kembar berikutnya sebesar 10 kali lipat.</span></li>
<li class="MsoNormal" style="text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Morbiditas neonatus turun bila persalinan dilakukan pada kehamilan 37 – 38 minggu.</span></li>
</ul><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">L.PENATALAKSANAAN</span></u></b></div><div class="MsoNormal" style="color: #d9ead3; text-indent: 36pt;"><i><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Penanganan dalam Kehamilan</span></u></i><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Prenatal yang baik untuk mengenal kehamilan kembar dan mencegah komplikasi yang timbul, dan bila diagnosa telah ditegakkan periksa akan lebih sering (1kali seminggu pada kehamilan 32 minggu ke atas).</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Setelah kehamilan 30 minggu, koitus dan perjalanan jauh dilarang, karena akan merangsang partus premafurus. </span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pemakaian gurita korset yang tidak terlalu ketat dibolehkan, supaya terasa lebih ringan.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pemeriksaan darah lengkap.<br />
<br />
</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify;"><i><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Penanganan dalam Persalinan</span></u></i><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Bila anak satu letaknya membujur, kala satu diawasi seperti biasa ditolong seperti biasa dengan episiotomi mediolateralis.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 38.1pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Setelah itu baru waspada, lakukan periksa luar, periksa dalam untuk menentukanKeadaan janin II. Tunggu, sambil memeriksa tekanan darah itu dan lain-lain.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 76.15pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Biasanya dalam 10-15 menit his akan kuat lagi. Bila janin II letaknya<br />
membujur, ketuban dipecahkan pelan-pelan supaya air ketuban tidak deras mengalir keluar.Tunggu dan pimpinan persalinan anak II seperti biasa.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 76.15pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Awas akan kemungkinan terjadinya perdarahan post partum, maka sebaiknya<br />
dipasang infuse profilaksis.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 76.15pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Bila ada kelainan letak anak II, melintang atau terjadi prolaps tali pusat dan<span> </span>solusio plasentae, maka janin dilahirkan dengan cara operatif obstetric;<br />
a. Pada letak lintang coba versi luar dulu.<br />
b. Atau lahirkan dengan cara versi dan ekstrasi.<br />
c. Pada letak kepala persalinan dipercepat dengan ekshasi vakum atau <span> </span>forseps.<br />
d. Pada letak bokong atau kaki; ekstraksi bokong atau kaki.<br />
~ Indikasi section caecarea hanya pada;<br />
a. Janin I letak lintang.<br />
b. Terjadi prolaps tali pusat.<br />
c. Plasenta praevia.<br />
d. Terjadi interlocking pada letak kedua janin 69; anak satu letak sungsang dan anak II letak kepala.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 76.15pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Courier New"; font-size: 12pt; line-height: 115%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kala IV diawasi terhadap kemungkinan terjadinya perdarahan postpartum; berikan suntikan sinto-metrin yaitu l0 satuan sintosinon tambah 0,2 mg methergin intravena.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3;"><i><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Persalinan </span></u></i><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></u></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pasien harus segera ke rumah sakit bila muncul tanda awal persalinan, KPD atau mengalami perdarahan pervaginam.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Penilaian klinis dilakukan seperti pada umumnya proses persalinan normal.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Persiapan-persiapan yang perlu untuk tindakan bedah sesar yang mungkin dikerjakan.</span></div><div class="MsoNormal" style="color: #d9ead3;"><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Klasifikasi presentasi intrapartum</span></i><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"> :</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><ol start="1" style="color: #d9ead3;" type="1"><li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Vertex – Vertex ( 40%)</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Vertex – nonVertex , bokong atau lintang ( 20% )</span></li>
</ol><div class="MsoNormal" style="color: #d9ead3;"><span lang="IN"><a href="http://lh5.ggpht.com/_ezSsIEHCzdA/SqTT5tMq0NI/AAAAAAAAAhU/LwFwhCgEb1Q/s1600-h/clip_image002%5b13%5d%5b3%5d.jpg"><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%; text-decoration: none;"> </span></a></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3;"><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kiri : presentasi vertex-vertex</span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">;<i>Kanan presentasi Vertex- presentasi bokong</i></span></div><div class="MsoNormal" style="color: #d9ead3;"><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Penatalaksanaan persalinan</span></i><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"> :</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><ul style="color: #d9ead3;" type="disc"><li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Posisi janin pertama harus ditentukan saat masuk kamar bersalin.</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Bila janin pertama letak lintang atau letak sungsang maka persalinan diakhiri dengan sectio caesar.</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Bila janin pertama letak kepala, dapat dipertimbangkan persalinan pervaginam.</span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Bila janin pertama letak sungsang dan janin letak kepala, dikhawatirkan terjadi interlocking sehingga persalinan anak pertama mengalami<i> “after coming head”</i></span></li>
<li class="MsoNormal"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Setelah janin pertama lahir, biasanya kontraksi uterus menghilang atau berkurang sehingga tidak jarang bahwa kontraksi uterus perlu diperkuat dengan pemberian oksitosin infuse setelah dipastikan anak ke II dapat lahir pervaginam.</span></li>
</ul><div align="center" class="MsoNormal" style="color: #d9ead3; text-align: center;"><span lang="IN"><a href="http://lh5.ggpht.com/_ezSsIEHCzdA/SqTT8wttZAI/AAAAAAAAAhc/DS3J-lbbBhg/s1600-h/clip_image002%5b15%5d%5b3%5d.jpg"><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%; text-decoration: none;"> </span></a></span><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></i></div><div align="center" class="MsoNormal" style="color: #d9ead3; text-align: center;"><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 10pt; line-height: 115%;">Mekanisme Interlocking pada persalinan kemba</span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 10pt; line-height: 115%;">r</span></div><div align="center" class="MsoNormal" style="color: #d9ead3; margin-left: 20.1pt; text-align: center;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;">ASKEP PADA KLIEN DENGAN GANGGUAN PATOLOGIK KEHAMILAN</span></u></b></div><div align="center" class="MsoNormal" style="color: #d9ead3; margin-left: 20.1pt; text-align: center;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 14pt; line-height: 115%;">(KEHAMILAN KEMBAR)</span></u></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 21.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">PENGKAJIAN</span></u></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 57.3pt; text-indent: -18pt;"><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Anamnesa;</span></i></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Perut lebih buncit dari semestinya tua kehamilan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Gerakan janin lebih banyak dirasakan ibu hamil. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Uterus terasa lebih cepat membesar. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pernah hamil kembar atau ada sejarah keturunan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 57.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Inspeksi dan palpasi</span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pada pemeriksaan pertama dan ulang pada kesan uterus lebih besar dan cepat tumbuhnya dari biasa.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Teraba gerakan-gerakan janin lebih banyak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Banyak bagian-bagian kecil teraba</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Teraba tiga bagian besar janin</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 78pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Teraba 2 balotemen</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 57.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Auskultasi<br />
Terdengar dua denyut jantung janin pada 2 tempat yang agak berjauhan dengan perbedaan kecepatan sedikitnya l0 denyut per menit atau sama-sama dihitung dan berselisih 10.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 57.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Rontgen foto abdomen : kelihatan 2 janin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 57.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Ultrasonografi : kelihatan 2 janin, dua jantung yang berdenyut telah dapat ditentukan pada triwulan I.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 57.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Elektrokardiogram fetal : diperoleh dua EKG yang berbeda dari kedua janin</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 57.3pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Reaksi kehamilan : Karena pada hamil kembar umumnya plasenta besar atau ada dua plasenta" maka produksi HCG akan tinggi; jadi reaksi kehamilan titrasi bisa positif kadang-kadang sampai 1/200. Hal ini dapat meragukan dengan molahidatidosa.<br />
Kadang kala diagnosa baru diketahui setelah bayi pertama lahir, uterus masih besar dan ternyata ada satu janin lagi dalam rahim. Kehamilan kembar sering bersamaan dengan hidramnion dan toksemia gravidarum.<br />
<br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 57.3pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Pengaruh Terhadap Ibu dan janin<br />
Terhadap ibu:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 93.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kebutuhan akan zat-zat bertambah sehingga dapat menyebabkan anemia dan defi siensi zat-zat lainnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 93.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Frekuensi hidramnion bertambah 10 kali lebih besar.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 93.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Frekuensi pre-eklamsi dan eklamsi lebih sering.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 93.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Karena uterus yang besar, wanita mengeluh: sesak nafas, sering miksi, edema dan varises pada tungkai dan vulva.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 93.3pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Dapat terjadi: inersia uteri, perdarahan postpartum dan solusio plasenta dan sesudah anak pertama lahir.</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 2cm;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Terhadap janin:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 99.25pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Usia kehamilam tambah pendek dengan jumlah janin pada kehamilan kembar : 25% pada gemelli, 50% pada triplet dan 75% pada quadruplet akan lahir 4 minggu sebelum cukup bulan. Jadi bayi premature akan tinggi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 99.25pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Bila sesudah bayi pertama lahir terjadi solusio plasentae, angka kematian bayi kedua tinggi.</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 99.25pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Sering terjadi kesalahan letak janin, yang juga akan mempertinngi angka kematian janin.</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #d9ead3;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">2.DIAGNOSA KEPERAWATAN</span></u></b></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Adapun diagnosa keperawatan yang muncul pada kehamilan gemeli yaitu:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 99.25pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol;"><span><img alt="*" height="12" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="12" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Risiko terjadinya gangguan perfusi jaringan berhubungan dengan adanya resiko perdarahan</span><span lang="IN" style="font-family: "Cambria","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 99.25pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol;"><span><img alt="*" height="12" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="12" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kecemasan berhubungan dengan perubahan status kesehatan.</span><span lang="IN" style="font-family: "Cambria","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 99.25pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 14.2pt; text-align: justify; text-indent: -14.2pt;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">RENCANA INTERVENSI</span></u></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 63.8pt; text-indent: -14.15pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Tujuan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 99.25pt; text-indent: -10.9pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">ibu dapat melewati masa kehamilan dengan baik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 99.25pt; text-indent: -10.9pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>KU ibu tetap dalam keadaan normal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 63.8pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Criteria keberhasilan </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 101.75pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Ibu<span> </span>dapat berdaptasi dengan kehamilan. <span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 101.75pt; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Ibu sehat, TTV dalam batas normal<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 0cm; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Rencana tindakan keperawatan yang akan dilaksanakan untuk menanggulangi masalah sesuai dengan diagnosa keperawatan yang telah ditentukan,yaitu:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 0cm; text-align: justify;"><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">DIAGNOSA 1</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">:</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 18pt; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Risiko terjadinya gangguan perfusi jaringan berhubungan dengan adanya resiko perdarahan</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><br />
<b><i>Tujuan</i></b> : Klien akan menunjukkan gangguan perfusi jaringan perifer tidak terjadi <br />
<b><i>Kriteria Hasil</i></b><i> :<span> </span><br />
</i><span> </span>Hb dalam batas</span><span lang="IN" style="font-family: Symbol;"><span>ü</span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"> normal (12-14 g%)<span> </span><br />
<span> </span>Turgor kulit baik</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><br />
<span> </span>Vital sign dalam batas</span><span lang="IN" style="font-family: Symbol;"><span>ü</span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"> normal<span> </span><br />
<span> </span>Tidak ada mual muntah</span><i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"></span></i><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><br />
<b><i>Intervensi </i></b></span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Awasi tanda-tanda vital, kaji warna kulit/membran mukosa, dasar kuku<br />
<b>Ras<i>ional</i></b><i> : </i>Memberika informasi tentang derajat/keadekuatan perfusi jaringan dan <span> </span>membantu menentukan intervensi selanjutnya<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Selidiki perubahan tingkat kesadaran, keluhan pusing dan sakit kepala<br />
<b><i>Rasiona</i>l</b> : Perubahan dapat menunjukkan ketidak adekuatan perfusi serebral sebagai akibat tekanan darah arterial<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kaji kulit terhadap dingin, pucat, berkeringat, pegisian kapiler lambat dan nadi perifer lemah<span> </span><br />
<b><i>Rasional</i> </b>:Vasokonstriksi adalah respon simpatis terhadap penurunan volume sirkulasi dan dapat terjadi sebagai efek samping vasopressin<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Berikan cairan intravena, produk darah<span> </span><br />
<b><i>Rasional</i> </b>: Menggantikan kehilangan daran, mempertahankan volume sirkulasi<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Penatalaksanaan pemberian obat antikoagulan tranexid 500 mg 3×1 tablet<span> </span><br />
<b><i>Rasional</i></b> : Obat anti kagulan berfungsi mempercepat terjadinya pembekuan darah / mengurangi perarahan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kecemasan berhubungan dengan perubahan status kesehatan</span></b><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span><br />
<b><i>Tujuan</i></b> : Klien akan menunjukkan kecemasan berkurang/hilang <span> </span><br />
<b><i>Kriteria Hasil</i></b><i> </i>: <span> </span><br />
<span> </span>Ekspresi wajah tenang</span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><br />
Klien tidak sering bertanya tentang penyakitnya<span> </span><br />
<b><i>Intervensi</i></b><i> :<span> </span></i></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 75pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kaji tingkat kecemasan klien<span> </span><br />
<b><i>Rasional</i></b> : Mengetahui sejauh mana kecemasan tersebut mengganggu klien<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 75pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Beri kesempatan pada klien untuk mengungkapkan perasaannya<span> </span><br />
<b><i>Rasional</i></b><i> </i>: Ungkapan perasaan dapat memberikan rasa lega sehingga mengurangi <span> </span>kecemasan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 75pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Mendengarkan keluhan klien dengan empati<span> </span><br />
<b><i>Rasional</i> </b>: Dengan mendengarkan keluahan klien secara empati maka klien akan merasa diperhatikan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 75pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Jelaskan pada klien tentang proses penyakit dan terapi yang diberikan<br />
<b><i>Rasional</i></b> : menambah pengetahuan klien sehingga klien tahu dan mengerti tentang penyakitnya</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; margin-left: 75pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Beri dorongan spiritual/support<span> </span><br />
<b><i>Rasiona</i>l</b> : Menciptakan ketenangan batin sehingga kecemasan dapat berkurang</span></div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: #d9ead3; text-align: justify;"><b><u><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">4.EVALUASI</span></u></b></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Kecemasan berhubungan dengan perubahan status kesehatan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; margin-left: 49.5pt; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">S : klien menyatakan kesadaran perasaan ansietas dan cara sehat<span> </span><span> </span>menerimanya</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>O : menunjukkan sikap rileks</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>A : ansietas teratasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>P : RT dihentikan</span></div><div class="MsoListParagraphCxSpLast" style="color: #d9ead3; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;">Risiko terjadinya gangguan perfusi jaringan berhubungan dengan adanya perdarahan</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 18pt; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>S :<span> </span>-</span></div><div class="MsoNormal" style="color: #d9ead3; margin-left: 18pt; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>O : perfusi adekuat, nadi perifer kuat, TTV normal, pasien sadar</span></div><div class="MsoListParagraphCxSpFirst" style="color: #d9ead3; text-align: justify;"><span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>A : tidak terjadi gangguan perfusi jaringan</span></div><div style="color: #d9ead3;"> <span lang="IN" style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span> </span>P : RT dihentikan</span></div><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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mso-ascii-theme-font:minor-latin;
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</style> <![endif]--><b style="color: #fff2cc;"><span style="font-family: "Times New Roman","serif"; font-size: 28pt; line-height: 115%;"> </span></b><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;">DEFINISI <span> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suatu Kehamilan yang ditandai dengan adanya villi korialis yang tidak normal secara histologis yang terdiri dari beberapa macam tingkatan proliferasi trofoblastik dan edema pada stroma villus. Biasanya kehamilan mola terjadi di dalam uterus, tetapi kadang2 terdapat juga di saluran telur ataupun ovarium.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mola hidatidosa</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah chorionic villi (jonjotan/gantungan) yang tumbuh berganda berupa gelembung-gelembung kecil yang mengandung banyak cairan sehingga menyerupai buah anggur atau mata ikan. Karena itu disebut juga hamil anggur atau mata ikan.<br />
(<b><i>Mochtar, Rustam, dkk</i></b>, 1998 : 238)</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mola hidatidosa</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah kehamilan abnormal, dengan ciri-ciri stoma villus korialis langka, vaskularisasi dan edematus. Janin biasanya meninggal akan tetapi villus-villus yang membesar dan edematus itu hidup dan tumbuh terus, gambaran yang diberikan adalah sebagai segugus buah anggur. (<b><i>Wiknjosastro, Hanifa, dkk</i></b>, 2002 : 339)<br />
<span> </span><span> </span><b>Mola hidatidosa</b> adalah kehamilan abnormal di mana hampir seluruh villi kariolisnya mengalami perubahan hidrofobik.</span></div><ul style="color: #fff2cc; margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kehamilan yang berkembang tidak wajar</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ditemukan janin</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hampir seluruh villi korialis mengalami perubahan hidropik</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila disertai janin atau bagian janin disebut Mola parsial</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembuahan sel telur yang kehilangan intinya atau inti tidak aktif lagi</span></li>
</ul><div class="MsoListParagraph" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;">FAKTOR RESIKO</span></b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"></span></div><ul style="color: #fff2cc; margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Defek pada ovarium</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">abnormalitas pada uterus</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">defisiensi nutrisi antara lain defisiensi protein, asam folat, karoten</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">umur dibawah 20 tahun atau</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">usia diatas 40 tahun : memiliki peningkatan resiko 7x dibanding perempuan yang lebih muda</span></li>
</ul><div class="MsoListParagraph" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;">GEJALA</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Derajat keluhan mual muntah lebih hebat</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Uterus lebih besar dari usia kehamilan</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan mrpk gejala utama</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadi pada bulan 1-7, rata2 usia kehamilan 12-14 minggu</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 10pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan bisa sampai syok dan meninggal</span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"><span> </span>KLASIFIKASI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pembagian mola berdasarkan dengan adanya janin atau tidak</span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mola hidatidosa komplit</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Villi korion berubah menjadi massa vesikel dengan ukuran bervariasi dari sulit terlihat sehingga diameter beberapa centimeter. Histologinya memiliki karekteristik, yaitu </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><ul style="color: #fff2cc; margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat degenerasi hidrofik & pembengkakan stroma villi</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ada pembuluh pada villi yang membengkak</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proliferasi dari epitel trofoblas dengan bermacam2 ukuran</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak adanya janin atau amnio</span></li>
</ul><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mola Hidatidosa parsial</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Masih tampak gelembungt yang disertai janin atau bagian dari janin. Umumnya janin masih hidup dalam bulan pertama. Tetapi ada juga yang hidup sampai aterm. Pada pemeriksaan histopatologik tampak di beberapa tempat villi yang edema dengan sel trofoblas yang tidak begitu berproliferasi, sedangkan tempat lain masih banyak yang normal.</span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;">PATOGENESIS </span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada beberapa teori yang diajukan untuk menerangkan patogenesis dari penyakit trofoblast :</span></div><ul style="color: #fff2cc; margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Teori missed abortion</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></li>
</ul><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mudigah mati pada kehamilan 3 – 5 minggu karena itu terjadi gangguan peredarah darah sehingga terjadi penimbunan cairan masenkim dari villi dan akhirnya terbentuklah gelembung-gelembung.</span></div><ul style="color: #fff2cc; margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Teori neoplasma dari Park</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></li>
</ul><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel-sel trofoblast adalah abnormal dan memiliki fungsi yang abnormal dimana terjadi reabsorbsi cairan yang berlebihan ke dalam villi sehigga timbul gelembung.</span></div><ul style="color: #fff2cc; margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Studi dari Hertig</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></li>
</ul><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Studi dari Hertig lebih menegaskan lagi bahwa mola hidatidosa semata-mata akibat akumulasi cairan yang menyertai degenerasi awal atau tiak adanya embrio komplit pada minggu ke tiga dan ke lima. Adanya sirkulasi maternal yang terus menerus dan tidak adanya fetus menyebabkan trofoblast berproliferasi dan melakukan fungsinya selama pembentukan cairan. (<b><i>Silvia, Wilson</i></b>, 2000 : 467)</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Karakteristik mola adalah adanya konseptus jaringan trofoblastik hiperplastik yang tertanam pada plasenta. Hasil konsepsi ini tidak memiliki <i>inner cell mass</i>.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Jika terjadi gangguan pada saat <i>embryonic inner cell mass</i> yang seharusnya berpotensi untuk berdiferensiasi menjadi lapisan ekto, meso dan endoderm, maka perubahan tersebut gagal dan terjadilah pembentukan trofoblas yang akan berkembang menjadi sitotorofoblas dan sisitiotrofoblas, danmasih mampu untuk membentuk ekstraembrionik mesoderm yang akhirnya akan membentuk vesikel dari mola dengan mesoderm yang longgar pada inti villinya.</span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;">DIAGNOSIS</span></b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"></span></div><ul style="color: #fff2cc; margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Amenore/tidak haid</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan pervaginam</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Uterus lebih besar dari usia kehamilan</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ditemukan tanda kehamilan pasti seperti balotemen dan bunyi jantung janin</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">β-hCG dalam darah atau urin</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Foto abdomen, biopsi transplasental, sonde uterus diputar, USG</span></li>
</ul><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt; line-height: 150%;"><span>G.</span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt; line-height: 150%;">MORTALITAS & MORBIDITAS (ANGKA KEMATIAN & KESAKITAN)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 18pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: 27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada Mola 20% berkembang menjadi keganasan trofoblastik. Setelah terbentuk mola komplit, invasi ke uterus terjadi pada 15% pasien & metastasis terjadi pada 4% pasien. Kasus koriokarsinoma yang berkembang dari mola partial belum pernah dilaporkan, walaupun 4% pasien dengan mola parsial akan berkembang menjadi penyakit trofoblastik non metastasis persisten yang membutuhkan kemoterapi.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Makroskopik<br />
</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gelembung-2 putih, tembus pandang, berisi cairan jernih, dengan ukuran bervariasi dari beberapa milimeter sampai satu atau 2 cm</span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt; line-height: 150%;"><span>H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt; line-height: 150%;"><span> </span>KOMPLIKASI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bisa disertai preeklampsia pada usia kehamilan yang lebih muda</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tirotoksikosis, prognosis lebih buruk, biasanya meninggal akibat krisis tiroid</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Emboli sel trofoblas ke paru</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sering disertai kista lutein, baik unilateral maupun bilateral, kista menghilang jika mola sudah dievakuasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mola dengan kista lutein mempunyai resiko 4x lebih besar berdegenerasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"><span>I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;">TERAPI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 18pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perbaikan keadaan umum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengeluaran jaringan mola (Evakuasi)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Profilaksis dengan sitostatika</span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan tindak lanjut (Follow up)</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: 18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perbaikan keadaan umum</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Transfusi darah jika anemia atau syok<br />
Menghilangkan penyulit seperti preeklampsia dan tirotoksikosa</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: 18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evakuasi Mola</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kuret hisap (Vakum) : Sambil diberikan uterotonika untuk memperbaiki kontraksi, sedia darah<br />
Histerektomi : cukup umur atau cukup anak, bila ditemukan tanda2 keganasan berupa mola invasif</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Profilaksis dengan sitostatika</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Kasus mola dengan resiko tinggi akan terjadinya keganasan, atau pada pemeriksaan Patologi Anatomi ditemukan mencurigakan tanda keganasan<br />
Methotrexate atau actinomycin D<br />
Dapat menghindarkan keganasan dengan metastasis, mengurangi koriokarsinoma diuterus sebanyak 3x</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Follow up</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dianjurkan untuk tidak hamil 1 tahun<br />
Kondom atau pil KB<br />
Pemeriksaan β-hCG berkala dan radiologi</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: 18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prognosis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kematian akibat perdarahan, infeksi, eklampsia, penyakit jantung atau krisis tiroid<br />
di negara berkembang 2,2 % dan 5,7%<br />
Proses keganasan berlangsung antara 7 hari sampai 3 tahun pasca mola, yang paling banyak 6 bulan pertama<br />
Bisa melahirkan normal setelah th/mola</span></div><div align="center" class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 20pt; line-height: 150%;">ASUHAN KEPERAWATAN PADA KLIEN DENGAN KELAINAN KEHAMILAN MOLA HIDATIDOSA</span></div><div class="MsoNormal" style="color: #fff2cc; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 13.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 18pt; line-height: 115%;">KONSEP ASUHAN KEPERAWATAN<span> </span><br />
</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span> </span><span> </span>Proses keperawatan adalah metode kerja dalam pemberian pelayanan keperawatan untuk menganalisa masalah pasien secara sistematis, menentukan cara pemecahannya, melakukan tindakan dan mengevaluasi hasil tindakan yang telah dilaksanakan.<span> </span> <br />
<span> </span><span> </span>Proses keperawatan adalah serangkaian perbuatan atau tindakan untuk menetapkan, merencanakan danmelaksanakan pelayanan keperawatan dalam rangka membantu klien untuk mencapai dan memelihara kesehatannya seoptimal mungkin. Tindakan keperawatan tersebut dilaksanakan secara berurutan, terus menerus, saling berkaitan dan dinamis.<span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 18pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENGKAJIAN</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><br />
</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Pengkajian adalah pendekatan sistematis untuk mengumpulkan data dan <span> </span><span> </span>menganalisanya sehingga dapat diketahui masalah dan kebutuhan perawatan bagi klien.<span> </span><br />
<span> </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun hal-hal yang perlu dikaji adalah : </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biodata</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Mengkaji identitas klien dan penanggung yang meliputi : nama, umur, agama, suku bangsa, pendidikan, pekerjaan, status perkawinan, perkawinan ke-, lamanya perkawinan dan alamat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat keperawatan </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluhan utama</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Kaji adanya menstruasi tidak lancar dan adanya perdarahan pervaginam berulang<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, yang terdiri atas : </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Riwayat kesehatan sekarang yaitu keluhan sampai saat klien pergi ke Rumah Sakit atau pada saat pengkajian seperti perdarahan pervaginam di luar siklus haid, pembesaran uterus lebih besar dari usia kehamilan.<span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Cambria","serif"; font-size: 12pt; line-height: 115%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Riwayat kesehatan masa lalu<span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.05pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat pembedahan : Kaji adanya pembedahan yang pernah dialami oleh klien, jenis pembedahan , kapan , oleh siapa dan di mana tindakan tersebut berlangsung.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.05pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat penyakit yang pernah dialami : Kaji adanya</span><span style="font-family: Symbol;"><span>Ø</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> penyakit yang pernah dialami oleh klien misalnya DM , jantung , hipertensi , masalah <span> </span>ginekologi/urinary, penyakit endokrin , dan penyakit-penyakit lainnya.<span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.05pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan keluarga : Yang dapat dikaji melalui genogram dan dari genogram tersebut dapat diidentifikasi mengenai penyakit turunan dan penyakit menular yang terdapat dalam keluarga.<span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.05pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan reproduksi : Kaji tentang mennorhoe, siklus menstruasi, lamanya, banyaknya, sifat darah, bau, warna dan adanya dismenorhoe serta kaji kapan menopause terjadi, gejala serta keluahan yang menyertainya</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.05pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kehamilan , persalinan dan nifas : Kaji bagaimana keadaan anak klien mulai dari dalam kandungan hingga saat ini, bagaimana keadaan kesehatan anaknya.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.05pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat seksual : Kaji mengenai aktivitas seksual klien, jenis kontrasepsi yang digunakan serta keluahn yang menyertainya.<span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.05pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat pemakaian obat : Kaji riwayat pemakaian obat-</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">obatan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kontrasepsi oral, obat digitalis dan jenis obat lainnya.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 103.05pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola aktivitas sehari-hari : Kaji mengenai nutrisi, cairan dan elektrolit, eliminasi (BAB dan BAK), istirahat tidur, hygiene, ketergantungan, baik sebelum dan saat sakit.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pemeriksaan fisik, </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">meliputi : <span> </span><br />
<br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 74.7pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Inspeksi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah proses observasi yang sistematis yang tidak hanya terbatas pada penglihatan tetapi juga meliputi indera pendengaran dan penghidung.<span> </span><br />
Hal yang diinspeksi antara lain : <span> </span>mengobservasi kulit terhadap warna, perubahan warna, laserasi, lesi terhadap drainase, pola pernafasan terhadap kedalaman dan kesimetrisan, bahasa tubuh, pergerakan dan postur, penggunaan ekstremitas, adanya keterbatasan fifik, dan seterusnya<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 74.7pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Palpasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah menyentuh atau menekan permukaan luar tubuh dengan jari. <br />
<span> </span>Sentuhan : merasakan suatu pembengkakan, mencatat suhu, derajat kelembaban dan tekstur kulit atau menentukan kekuatan kontraksi uterus. <span> </span><br />
<span> </span>Tekanan : menentukan karakter nadi, mengevaluasi edema, memperhatikan posisi janin atau mencubit kulit untuk mengamati turgor. <span> </span><br />
<span> </span>Pemeriksaan dalam : menentukan tegangan/tonus otot atau respon nyeri yang abnormal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 74.7pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perkusi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah melakukan ketukan langsung atau tidak langsung pada permukaan tubuh tertentu untuk memastikan informasi tentang organ atau jaringan yang ada dibawahnya. </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span> </span>Menggunakan jari : ketuk lutut dan dada dan dengarkan bunyi yang menunjukkan ada tidaknya cairan , massa atau konsolidasi.<span> </span> <br />
<span> </span>Menggunakan palu perkusi : ketuk lutut dan amati ada tidaknya refleks/gerakan pada kaki bawah, memeriksa refleks kulit perut apakah ada kontraksi dinding perut atau tidak<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 74.7pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Auskultasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah mendengarkan bunyi dalam tubuh dengan bentuan stetoskop dengan menggambarkan dan menginterpretasikan bunyi yang terdengar. Mendengar : mendengarkan di ruang antekubiti untuk tekanan darah, dada untuk bunyi jantung/paru abdomen untuk bising usus atau denyut jantung janin.<span> </span><br />
(<b>Johnson & Taylor</b>, 2005 : 39)<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan laboratorium :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span> </span><br />
Darah dan urine serta pemeriksaan penunjang : rontgen, USG, biopsi, pap smear. <br />
Keluarga berencana : Kaji mengenai pengetahuan klien tentang KB,</span><span style="font-family: Symbol;"><span>ü</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> apakah klien setuju, apakah klien menggunakan kontrasepsi, dan menggunakan KB jenis apa.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data lain-lain :</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji mengenai perawatan dan pengobatan yang telah diberikan selama dirawat di RS.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data psikososial</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji orang terdekat dengan klien, bagaimana pola</span><span style="font-family: Symbol;"><span>ü</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> komunikasi dalam keluarga, hal yang menjadi beban pikiran klien dan mekanisme koping yang digunakan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Status sosio-ekonomi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Kaji masalah finansial klien<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data spiritual</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Kaji tentang keyakina klien terhadap Tuhan YME, dan kegiatan keagamaan yang biasa dilakukan.<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;">DIAGNOSA KEPERAWATAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;"><span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Secara singkat diagnosa keperawatan dapat diartikan : Sebagai rumusan atau keputusan atau keputusan yang diambil sebagai hasil dari pengkajian keperawatan. Diagnosa keperawatan adalah pernyataan yang digambarkan sebagai respon seseorang atau kelompok (keadan kesehatan yang merupakan keadaan aktual maupun potensial) dimana perawat secara legal mengidentifikasi, menetapkan intervensi untuk mempertahankan keadaan kesehatan atau menurunkan. (<b>Carpenito, Lynda,</b> 2001: 45)<span> </span><br />
Diagnosa keperawatan yang lazim muncul pada kasus ”mola hidatidosa” adalah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri berhubungan dengan terputusnya kontinuitas jaringan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intoleransi aktivitas berhubungan dengan kelemahan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pola tidur berhubungan dengan adanya nyeri<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman : hipertermi berhubungan dengan proses infeksi<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecemasan berhubungan dengan perubahan status kesehatan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko nutrisi kurang dari kebutuhan berhubungan dengan mual muntah<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko terjadi infeksi berhubungan dengan tindakan kuretase<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko terjadinya gangguan perfusi jaringan berhubungan dengan adanya perdarahan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">INTERVENSI</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Merupakan tahapan perencanaan dari proses keperawatan merupakan tindakan menetapkan apa yang akan dilakukan untuk membantu klien, memulihkan, memelihara dan meningkatkan kesehatannya.<span> </span><br />
Perencanaan keperawatan adalah penyusunan rencana tindakan keperawatan yang akan dilaksanakan untuk menanggulangi masalah sesuai dengan diagnosa keperawatan yang telah ditentukan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Tujuan :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebagai alat komunikasi antar teman sejawat dan tenaga kesehatan lain<span> </span></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan keseimbangan asuhan keperawatan<span> </span></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Langkah-langkah penyusunan :<span> </span></span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menetapkan prioritas masalah<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merumuskan tujuan keperawatan yang akan dicapai<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menentukan rencana tindakan keperawatan<span> </span><br />
</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DIAGNOSA I </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri berhubungan dengan terputusnya kontinuitas jaringan<span> </span><br />
<b>Tujuan</b> : Klien akan meninjukkan nyeri berkurang/hilang <span> </span><br />
<b>Kriteria Hasil</b> : </span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien mengatakan nyeri berkurang/hilang<span> </span><br />
Ekspresi wajah tenang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
TTV dalam batas normal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji tingkat nyeri, lokasi dan skala nyeri yang dirasakan klien<span> </span><br />
<b>Rasional</b> : Mengetahui tingkat nyeri yang dirasakan sehingga dapat membantu menentukan intervensi yang tepat<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi tanda-tanda vital tiap 8 jam<span> </span><br />
<b>Rasional</b> : Perubahan tanda-tanda vital terutama suhu dan nadi merupakan salah satu indikasi peningkatan nyeri yang dialami oleh klien<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan klien untuk melakukan teknik relaksasi<span> </span><br />
<b>Rasional </b>: Teknik relaksasi dapat membuat klien merasa sedikit nyaman dan distraksi dapat mengalihkan perhatian klien terhadap nyeri sehingga dapat mambantu mengurangi nyeri yang dirasakan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri posisi yang nyaman<span> </span><br />
<b>Rasional</b> : Posisi yang nyaman dapat menghindarkan penekanan pada area luka/nyeri</span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi pemberian analgetik<span> </span><br />
<b>Rasional </b>: Obat-obatan analgetik akan memblok reseptor nyeri sehingga nyeri tidat dapat dipersepsikan<span> </span></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DIAGNOSA II</span></b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intoleran aktivitas berhubungan dengan kelemahan<span> </span><br />
<b>Tujuan </b>: Klien akan menunjukkan terpenuhinya kebutuhan rawat diri <span> </span><br />
<b>Kriteria Hasil</b> : <span> </span><br />
Kebutuhan personal hygiene terpenuhi</span><span style="font-family: Symbol;"><span>ü</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Klien nampak rapi dan bersih<span> </span><br />
<b>Intervensi</b> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji kemampuan klien dalam memenuhi rawat diri<span> </span><br />
<b>Rasional :</b> Untuk mengetahui tingkat kemampuan/ketergantungan klien dalam merawat diri sehingga dapat membantu klien dalam memenuhi kebutuhan hygienenya</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu klien dalam memenuhi kebutuhan sehari-hari<span> </span><br />
<b>Rasional :</b> Kebutuhan hygiene klien terpenuhi tanpa membuat klien ketergantungan pada perawat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan klien untuk melakukan aktivitas sesuai kemampuannya<span> </span><br />
<b>Rasional : </b>Pelaksanaan aktivitas dapat membantu klien untuk mengembalikan kekuatan secara bertahap dan menambah kemandirian dalam memenuhi kebutuhannya</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan keluarga klien untuk selalu berada di dekat klien dan membantu memenuhi kebutuhan klien<span> </span></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Membantu memenuhi kebutuhan klien yang tidak terpenuhi secara mandiri</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DIAGNOSA III<span> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pola tidur berhubungan dengan adanya nyeri<span> </span><br />
<b>Tujuan </b>: Klien akan mengungkapkan pola tidurnya tidak terganggu<span> </span> <br />
<b>Kriteria Hasil</b> : <span> </span><br />
<span> </span>Klien dapat tidur 7-8 jam per hari</span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span> </span>Konjungtiva tidak anemis<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji pola tidur<span> </span><br />
<b>Rasional :</b> Dengan mengetahui pola tidur klien, akan memudahkan dalam menentukan intervensi selanjutnya<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ciptakan lingkungan yang nyaman dan tenang<span> </span><br />
<b>Rasional :</b>Memberikan kesempatan pada klien untuk beristirahat<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan klien minum susu hangat sebelum tidur<span> </span><br />
<b>Rasional</b> :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Susu mengandung protein yang tinggi sehingga dapat merangsang untuk tidur</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Batasi jumlah penjaga klien<span> </span><br />
<b>Rasional :</b> Dengan jumlah penjaga klien yang dibatasi maka kebisingan di ruangan dapat dikurangi sehingga klien dapat beristirahat<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberlakukan jam besuk<span> </span><br />
<b>Rasional :</b> Memberikan kesempatan pada klien untuk beristirahat<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan tim medis pemberian obat tidur Diazepam<span> </span><br />
<b>Rasional </b>: Diazepam berfungsi untuk merelaksasi otot sehingga klien dapat tenang dan mudah tidur<span> </span></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DIAGNOSA IV<span> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman : hipertermi berhubungan dengan proses infeksi<span> </span><br />
<b>Tujuan </b>: Klien akan menunjukkan tidak terjadi panas <span> </span><br />
<b>Kriteria Hasil</b> :<span> </span><br />
<span> </span>Tanda-tanda vital dalam batas normal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span> </span>Klien tidak <span> </span>mengalami komplikasi<span> </span><br />
<b>Intervensi </b>:<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau suhu klien, perhatikan menggigil/diaphoresis<span> </span><br />
<b>Rasional</b> : Suhu diatas normal menunjukkan terjadinya proses infeksi, pola demam dapat membantu diagnose<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau suhu lingkungan<span> </span><br />
<b>Rasional</b> : Suhu ruangan harus diubah atau dipertahankan, suhu harus mendekati normal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan untuk minum air hangat dalam jumlah yang banyak<span> </span><br />
<b>Rasional</b> : Minum banyak dapat membantu menurunkan demam<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan kompres hangat<span> </span><br />
<b>Rasional </b>: Kompres hangat dapat membantu penyerapan panas sehingga dapat menurunkan suhu tubuh<span> </span></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi pemberian obat antipiretik<span> </span><br />
<b>Rasional </b>: Digunakan untuk mengurangi demam dengan aksi pada <span> </span>hypothalamus</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DIAGNOSA V<span> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecemasan berhubungan dengan perubahan status kesehatan<span> </span><br />
<b>Tujuan</b> : Klien akan menunjukkan kecemasan berkurang/hilang <span> </span><br />
<b>Kriteria Hasil</b> : <span> </span><br />
<span> </span>Ekspresi wajah tenang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Klien tidak sering bertanya tentang penyakitnya<span> </span><br />
<b>Intervensi</b> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 75pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji tingkat kecemasan klien<span> </span><br />
<b>Rasional</b> : Mengetahui sejauh mana kecemasan tersebut mengganggu klien<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 75pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri kesempatan pada klien untuk mengungkapkan perasaannya<span> </span><br />
<b>Rasional</b> : Ungkapan perasaan dapat memberikan rasa lega sehingga mengurangi <span> </span>kecemasan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 75pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mendengarkan keluhan klien dengan empati<span> </span><br />
<b>Rasional </b>: Dengan mendengarkan keluahan klien secara empati maka klien akan merasa diperhatikan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 75pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jelaskan pada klien tentang proses penyakit dan terapi yang diberikan<br />
<b>Rasional</b> : menambah pengetahuan klien sehingga klien tahu dan mengerti tentang penyakitnya</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 75pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri dorongan spiritual/support<span> </span><br />
<b>Rasional</b> : Menciptakan ketenangan batin sehingga kecemasan dapat berkurang<span> </span><br />
</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DIAGNOSA VI<span> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko nutrisi kurang dari kebutuhan berhubungan dengan mual muntah<span> </span><br />
<b>Tujuan </b>: Klien akan mengungkapkan nutrisi terpenuhi <span> </span><br />
<b>Kriteria Hasil</b> : <span> </span><br />
<span> </span>Nafsu makan meningkat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span> </span>Porsi makan dihabiskan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<b>Intervensi</b> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji status nutrisi klien<span> </span><br />
<b>Rasional </b>: Sebagai awal untuk menetapkan rencana selanjutnya<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan makan sedikit demi sedikit tapi sering<span> </span><br />
<b>Rasional</b> : Makan sedikit demi sedikit tapi sering mampu membantu untuk<span> </span>meminimalkan anoreksia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan untuk makan makanan dalam keadaan hangat dan bervariasi<span> </span><br />
<b>Rasional </b>: Makanan yang hangat dan bervariasi dapat menbangkitkan nafsu makan klien<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Timbang berat badan sesuai indikasi<span> </span><br />
<b>Rasional</b> : Mengevaluasi keefektifan atau kebutuhan mengubah pemberian nutrisi<span> </span></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingkatkan kenyamanan lingkungan termasuk sosialisasi saat makan, anjurkan orang terdekat untuk membawa makanan yang disukai klien<span> </span><br />
<b>Rasional</b> : Sosialisasi waktu makan dengan orang terdekat atau teman dapat <span> </span><span> </span>meningkatkan pemasukan dan menormalkan fungsi makanan<span> </span></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span> </span>DIAGNOSA VII</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko terjadi infeksi berhubungan dengan tindakan kuretase<span> </span><br />
<b>Tujuan</b> : Klien akan terbebas dari infeksi <span> </span><br />
<b>Kriteria Hasil</b> :<span> </span><br />
<span> </span>Tidak tampak tanda-tanda</span><span style="font-family: Symbol;"><span>ü</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> infeksi<span> </span><br />
<span> </span>Vital sign dalam batas normal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<b>Intervensi</b> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji adanya tanda-tanda infeksi<span> </span><br />
<b>Rasional </b>: Mengetahui adanya gejala awal dari proses infeksi <span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi vital sign<span> </span><br />
<b>Rasional</b> : Perubahan vital sign merupakan salah satu indikator dari terjadinya proses infeksi dalam tubuh<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi daerah kulit yang mengalami kerusakan (luka, garis jahitan), daerah yang terpasang alat invasif (infus, kateter)<span> </span><br />
<b>Rasional</b> : Deteksi dini perkembangan infeksi memungkinkan untuk melakukan tindakan dengan segera dan pencegahan komplikasi selanjutnya<span> </span></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan tim medis untuk pemberian obat antibiotic<span> </span><br />
<b>Rasional </b>: Anti biotik dapat menghambat pembentukan sel bakteri, sehingga proses infeksi tidak terjadi. Disamping itu antibiotik juga dapat langsung membunuh sel bakteri penyebab infeks.<span> </span></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DIAGNOSA VIII</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko terjadinya gangguan perfusi jaringan berhubungan dengan adanya perdarahan<br />
<b>Tujuan</b> : Klien akan menunjukkan gangguan perfusi jaringan perifer tidak terjadi <br />
<b>Kriteria Hasil</b> :<span> </span><br />
<span> </span>Hb dalam batas</span><span style="font-family: Symbol;"><span>ü</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> normal (12-14 g%)<span> </span><br />
<span> </span>Turgor kulit baik</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span> </span>Vital sign dalam batas</span><span style="font-family: Symbol;"><span>ü</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> normal<span> </span><br />
<span> </span>Tidak ada mual muntah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<b>Intervensi </b></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Awasi tanda-tanda vital, kaji warna kulit/membran mukosa, dasar kuku<span> </span><br />
<b>Rasional</b> : Memberika informasi tentang derajat/keadekuatan perfusi jaringan dan <span> </span>membantu menentukan intervensi selanjutnya<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Selidiki perubahan tingkat kesadaran, keluhan pusing dan sakit kepala<br />
<b>Rasional</b> : Perubahan dapat menunjukkan ketidak adekuatan perfusi serebral sebagai akibat tekanan darah arterial<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji kulit terhadap dingin, pucat, berkeringat, pegisian kapiler lambat dan nadi perifer lemah<span> </span><br />
<b>Rasional </b>:Vasokonstriksi adalah respon simpatis terhadap penurunan volume sirkulasi dan dapat terjadi sebagai efek samping vasopressin<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan cairan intravena, produk darah<span> </span><br />
<b>Rasional </b>: Menggantikan kehilangan daran, mempertahankan volume sirkulasi<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan pemberian obat antikoagulan tranexid 500 mg 3×1 tablet<span> </span><br />
<b>Rasional</b> : Obat anti kagulan berfungsi mempercepat terjadinya pembekuan darah / mengurangi perarahan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;">EVALUASI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;"> </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Evaluasi adalah penilaian dengan cara membandingkan perubahan keadaan pasien (hasil yang diamati) dengan tujuan dan kriteria hasil yang dibuat pada tahap perencanaan. Tujuan dari evaluasi ini adalah untuk :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mengakhiri rencana tindakan keperawatan.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Memodifikasi<span> </span>rencana tindakan keperawatan.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Meneruskan rencana tindakan keperawatan.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></b></div><div class="MsoNormal" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span> </span></span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Evaluasi terbagi menjadi dua, yaitu evaluasi proses (formatif) dan evaluasi hasil (sumatif).</span></div><div class="MsoNormal" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Komponen evaluasi terdiri dari : </span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 74.7pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">S<span> </span>:<span> </span>data subjektif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 74.7pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">O<span> </span>:<span> </span>data obyektif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 74.7pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">A<span> </span>:<span> </span>analisis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 74.7pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">P<span> </span>:<span> </span>planning</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">EVALUASI PADA KLIEN DENGAN KELAINAN KEHAMILAN MOLA HIDATIDOSA</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluhan utama</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">menstruasi tidak lancar dan adanya perdarahan pervaginam berulang</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">) :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> teratasi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri berhubungan dengan terputusnya kontinuitas jaringan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">S : klien menyatakan “nyeri reda/terkontrol”</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">O : menunjukkan postur badan rileks, bebas bergerak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">A : nyeri teratasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">P : RT dihentikan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intoleransi aktivitas berhubungan dengan kelemahan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>S : klien melaporkan peningkatan toleransi aktifitas (aktifitas sehari-hari)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>O : menunjukkan penurunan tanda fisiologis intoleransi, mis TTV normal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>A : peningkatan toleransi aktifitas</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>P : RT dihentikan</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pola tidur berhubungan dengan adanya nyeri<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>S : melaporkan peningkatan rasa sehat dan dapat istirahat </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>O : tidur 6-8 jam setiap hari</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>A : kebutuhan tidur terpenuhi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>P : RT dihentikan</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman : hipertermi berhubungan dengan proses infeksi<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>S : klien merasa nyaman</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>O : TTV dalam kisaran normal, tidak ada tanda-tanda infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>A :<span> </span>tidak ada gangguan rasa nyaman</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>P : RT dihentikan</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecemasan berhubungan dengan perubahan status kesehatan<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span></span>S : klien menyatakan kesadaran perasaan ansietas dan cara sehat<span> </span><span> </span>menerimanya</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>O : menunjukkan sikap rileks</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>A : ansietas teratasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>P : RT dihentikan</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko nutrisi kurang dari kebutuhan berhubungan dengan mual muntah</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>S : klien merasa lebih baik tanpa adanya anoreksia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>O : menunjukkan peningkatan BB sesuai tujuan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>A : nutrisi terpenuhi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>P : RT dihentikan</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko terjadi infeksi berhubungan dengan tindakan kuretase<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>S :<span> </span>-</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>O : mencapai masa penyembuhan tepat waktu, tanpa bukti adanya infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>A : tidak terjadi infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>P : RT dihentikan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 46.35pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko terjadinya gangguan perfusi jaringan berhubungan dengan adanya perdarahan</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span>S :<span> </span>-</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span>O : perfusi adekuat, nadi perifer kuat, TTV normal, pasien sadar</span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span>A : tidak terjadi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">gangguan perfusi jaringan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span>P : RT dihentikan</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div class="MsoNormal" style="color: #fff2cc; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 22pt;">DAFTAR PUSTAKA</span></b><span style="font-family: "Times New Roman","serif"; font-size: 22pt;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Carpenito, Lynda</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (2001)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Buku Saku Diagnosa Keperawatan</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Penerbit Buku Kedokteran EGC</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Jakarta</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Doenges, Marilynn E. 1999. <i>Rencana asuhan keperawatan</i>. EGC: Jakarta </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hamilton, C. Mary</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> 1995</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dasar-dasar Keperawatan Maternitas</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, <i>edisi 6</i>, EGC</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Jakarta</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";"><a href="http://cakmoki86.wordpress.com/2007/02/16/hamil-anggur-apaan-sih/"><b><span style="font-size: 12pt; line-height: 150%;">http://cakmoki86.wordpress.com/2007/02/16/hamil-anggur-apaan-sih/</span></b></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman","serif";"><a href="http://cewexxxhot.blogspot.com/2009/09/askep-molahidatidosa.html">http://cewexxxhot.blogspot.com/2009/09/askep-molahidatidosa.html</a></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";"><a href="http://drnyol.info/obgyn-grey-zone/in-gynecology/mola-hidatidosa-hamil-anggur/"><span style="font-size: 12pt; line-height: 150%;">http://drnyol.info/obgyn-grey-zone/in-gynecology/mola-hidatidosa-hamil-anggur/</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";"><a href="http://harnawatiaj.wordpress.com/2008/05/10/askep-mola-hidatidosa/"><span style="font-size: 12pt; line-height: 150%;">http://harnawatiaj.wordpress.com/2008/05/10/askep-mola-hidatidosa/</span></a><a href="http://www.askep-askeb.cz.cc/2010/01/askep-mola-hidatidosa.html"><span style="font-size: 12pt; line-height: 150%;">http://www.askep-askeb.cz.cc/2010/01/askep-mola-hidatidosa.html</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Johnson & Taylor</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> 2005. <i>Buku Ajar Praktik Kebidanan</i>. EGC</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Jakarta</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mansjoer, Arif, dkk. 2001. <i>Kapita Selekta Kedokteran, Jilid I</i>. Media Aesculapius</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jakarta</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mochtar, Rustam</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> 1998. <i>Sinopsis Obstetri, Jilid I</i>. EGC</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Jakarta</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rohmah, Nikmatur, dkk. 2009.<span> </span><i>Proses Keperawatan Teori dan Aplikasi</i>. Ar-Ruzzmedia: Jogjakarta</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Soekojo, Saleh</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> 1973</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patologi</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> UI Patologi Anatomik</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Jakarta</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-67027357217086310782011-02-22T16:49:00.000-08:002011-02-22T16:49:09.478-08:00Askep Hiperbilirubinemia<!--[if !mso]> <style>
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</div><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-align: justify; text-indent: -22.5pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang</span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.5pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Ikterus terjadi apabila terdapat akumulasi bilirubin dalam darah. Pada sebagian neonatus, ikterus akan ditemukan dalam minggu pertama kehidupannya. Dikemukakan bahwa angka kejadian ikterus terdapat pada 60% bayi cukup bulan dan pada 80% bayi kurang bulan. Di Jakarta dilaporkan 32,19% menderita ikterus. Ikterus ini pada sebagian lagi mungkin bersifat patologik yang dapat menimbulkan gangguan yang menetap atau menyebabkan kematian, karenanya setiap bayi dengan ikterus harus mendapat perhatian terutama apabila ikterus ditemukan dalam 24 jam pertama kehidupan bayi atau kadar bilirubin meningkat lebih dari 5 mg/dl dalam 24 jam. Proses hemolisis darah, infeksi berat, ikterus yang berlangsung lebih dari 1 minggu serta bilirubin direk lebih dari 1 mg/dl juga merupakan keadaan yang menunjukkan kemungkinan adanya ikterus patologik. Dalam keadaan tersebut penatalaksanaan ikterus harus dilakukan sebaik-baiknya agar akibat buruk ikterus dapat dihindarkan.<span> </span></span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 40.5pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Rumusan <span> </span>Masalahan</span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: normal; margin: 0cm 0cm 0.0001pt 40.5pt; text-indent: 18pt;"><br />
</div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-indent: 18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">Berdasarkan </span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">uraian</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;"> latar belakang di atas, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">maka fokus </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">permasalahan dalam </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">makalah </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;"><span> </span>ini adalah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">Apa yang dimaksud dengan hiperbilirubunemia pada bayi?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">Bagaimana proses keperawatan pada klien dengan hiperbilirubinemia?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; letter-spacing: -0.2pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">Tujuan </span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-indent: 4.5pt;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">Berdasarkan rumusan permasalahan, maka makalah<span> </span>ini bertujuan untuk</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengetahui apa yang dimaksud dengan hiperbilirubinemia. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu menguasai pengetahuan dan keterampilan <span> </span><span> </span>yang berkaitan dengan asuhan keperawatan pada klien dan keluarga dengan bayi Ikterus (Hiperilirubinemia).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DASAR TEORI HIPERBILIRUBINEMIA</span></b></div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Definisi Hiperbilirubinemia<span> </span></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hiperbilirubinemia adalah berlebihnya akumulasi bilirubin dalam darah (level normal 5 mg/dl pada bayi normal) yang mengakibatkan jaundice, warna kuning yang terlihat jelas pada kulit, mukosa, sklera dan urine.<span></span>(Doenges, Marilyn E., Maternal.1988). </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.55pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus pada neonatus tidak selamanya patologis.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus fisiologis</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus fisiologis adalah Ikterus yang memiliki karakteristik sebagai berikut (Hanifa, 1987):</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Timbul pada hari kedua-ketiga. </span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kadar Biluirubin Indirek setelah 2 x 24 jam tidak melewati 15 mg% pada neonatus cukup bulan dan 10 mg % pada kurang bulan.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecepatan peningkatan kadar Bilirubin tak melebihi 5 mg % per hari.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kadar Bilirubin direk kurang dari 1 mg %.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus hilang pada 10 hari pertama.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak terbukti mempunyai hubungan dengan keadan patologis tertentu.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus Patologis / Hiperbilirubinemia</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adalah suatu keadaan dimana kadar Bilirubin dalam darah mencapai suatu nilai yang mempunyai potensi untuk menimbulkan Kern Ikterus kalau tidak ditanggulangi dengan baik, atau mempunyai hubungan dengan keadaan yang patologis. Brown menetapkan Hiperbilirubinemia bila kadar Bilirubin mencapai 12 mg% pada cukup bulan, dan 15 mg % pada bayi kurang bulan. Utelly menetapkan 10 mg% dan 15 mg%.</span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kern Ikterus</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adalah suatu kerusakan otak akibat perlengketan Bilirubin Indirek pada otak terutama pada Korpus Striatum, Talamus, Nukleus Subtalamus, Hipokampus, Nukleus merah , dan Nukleus pada dasar Ventrikulus IV. </span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></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="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Penyebab ikterus pada bayi baru lahir dapat berdiri sendiri ataupun dapat <span> </span>disebabkan oleh beberapa faktor:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peningkatan produksi :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hemolisis, misal pada Inkompatibilitas yang terjadi bila terdapat ketidaksesuaian golongan darah dan anak pada penggolongan Rhesus dan ABO.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pendarahan tertutup misalnya pada trauma kelahiran.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikatan Bilirubin dengan protein terganggu seperti gangguan metabolik yang terdapat pada bayi Hipoksia atau Asidosis .</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Defisiensi G6PD/ Glukosa 6 Phospat Dehidrogenase.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus ASI yang disebabkan oleh dikeluarkannya pregnan 3 (alfa), 20 (beta) , diol (steroid).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurangnya Enzim Glukoronil Transeferase , sehingga kadar Bilirubin Indirek meningkat misalnya pada berat lahir rendah. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan kongenital (Rotor Sindrome) dan Dubin Hiperbilirubinemia </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan transportasi akibat penurunan kapasitas pengangkutan misalnya pada Hipoalbuminemia atau karena pengaruh obat-obat tertentu misalnya Sulfadiasine. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan fungsi Hati yang disebabkan oleh beberapa mikroorganisme atau toksion yang dapat langsung merusak sel hati dan darah merah seperti Infeksi , Toksoplasmosis, Siphilis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan ekskresi yang terjadi intra atau ekstra Hepatik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peningkatan sirkulasi Enterohepatik misalnya pada Ileus Obstruktif.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></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="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejadian yang sering ditemukan adalah apabila terdapat penambahan beban bilirubin pada streptucocus hepar yang terlalu berlebihan. Hal ini dapat ditemukan bila terdapat peningkatan penghancuran eritrosit, polisitemia, memendeknya umur eritrosit janin/bayi, meningkatnya bilirubin dari sumber lain, atau terdapatnya peningkatan sirkulasi enterohepatik. Gangguan ambilan bilirubin plasma terjadi apabila kadar protein-Z dan protein-Y terikat oleh anion lain, misalnya pada bayi dengan asidosis atau dengan anoksia/hipoksia, ditentukan gangguan konjugasi hepar (defisiensi enzim glukuronii transferase) atau bayi menderita gangguan ekskresi, misalnya penderita hepatitis neonatal atau sumbatan saluran empedu intra/ekstra hepatika.<br />
<span> </span>Pada derajat tertentu, bilirubin ini akan bersifat toksik dan merusakan jaringan otak. Toksisitas ini terutama ditemukan pada bilirubin indirek. Sifat indirek ini yang memungkinkan efek patologik pada sel otak apabila bilirubin tadi dapat menembus sawar darah otak. Kelainan yang terjadi pada otak ini disebut kernikterus atau ensefalopati biliaris. Mudah tidaknya bilirubin melalui sawar darah otak ternyata tidak hanya tergantung dari tingginya kadar bilirubin tetapi tergantung pula pada keadaan neonatus sendiri. Bilirubin indirek akan mudah melalui sawar darah otak apabila pada bayi terdapat keadaan imaturitas. Berat lahir rendah, hipoksia, hiperkarbia, hipoglikemia dan kelainan susunan saraf pusat yang karena trauma atau infeksi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span> </span>(Markum, 1991).</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div align="center" class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skema Patofisiologi Hiperbilirubinemia</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="height: 35px; left: 0px; margin-left: 374px; margin-top: 37px; position: absolute; width: 12px; z-index: 251668480;"><img height="35" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="12" /></span><span style="height: 35px; left: 0px; margin-left: 238px; margin-top: 37px; position: absolute; width: 12px; z-index: 251667456;"><img height="35" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="12" /></span><span style="height: 18px; left: 0px; margin-left: 305px; margin-top: 21px; position: absolute; width: 2px; z-index: 251661312;"><img height="18" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="2" /></span><span style="height: 2px; left: 0px; margin-left: 243px; margin-top: 37px; position: absolute; width: 138px; z-index: 251662336;"><img height="2" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="138" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hemoglobin</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Globin<span> </span><span> </span>Heme</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span> <table align="left" cellpadding="0" cellspacing="0"><tbody>
<tr> <td height="0" width="343"><br />
</td> </tr>
<tr> <td><br />
</td> <td><img height="52" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="99" /></td> </tr>
</tbody></table></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><br clear="ALL" style="color: #fff2cc;" /> <div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 216pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 216pt; text-align: justify;"><span style="height: 39px; left: 0px; margin-left: 336px; margin-top: 24px; position: absolute; width: 12px; z-index: 251671552;"><img height="39" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="12" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Biliverdin<span> </span>Fe (zat besi)</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: center; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peningkatan destruksi eritrosit ( Gangguan konjungasi bilirubin / gangguan transport bilirubin / peningkatan siklus enterohepatik ) Hb dan eritrosit abnormal</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span> <table align="left" cellpadding="0" cellspacing="0"><tbody>
<tr> <td height="0" width="336"><br />
</td> </tr>
<tr> <td><br />
</td> <td><img height="38" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image006.gif" width="12" /></td> </tr>
</tbody></table></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><br />
</div><br clear="ALL" style="color: #fff2cc;" /> <div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemecahan bilirubin berlebih / bilirubin yang tidak berikan dengan albumin meningkat</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span style="position: relative; z-index: 251673600;"><span style="height: 58px; left: 343px; position: absolute; top: -2px; width: 12px;"><img height="58" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image007.gif" width="12" /></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;"><br />
</div><br clear="ALL" style="color: #fff2cc;" /> <div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: center; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suplay bilirubin melebihi kemampuan hepar</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;"><span> <table align="left" cellpadding="0" cellspacing="0"><tbody>
<tr> <td height="1" width="343"><br />
</td> </tr>
<tr> <td><br />
</td> <td><img height="44" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image008.gif" width="12" /></td> </tr>
</tbody></table></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><br />
</div><br clear="ALL" style="color: #fff2cc;" /> <div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: center; text-indent: 36pt;"><span style="height: 29px; left: 0px; margin-left: 343px; margin-top: 25px; position: absolute; width: 12px; z-index: 251675648;"><img height="29" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image009.gif" width="12" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hepar tidak mampu melakukan konjungasi</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: center; text-indent: 36pt;"><span style="height: 34px; left: 0px; margin-left: 343px; margin-top: 23px; position: absolute; width: 12px; z-index: 251676672;"><img height="34" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image010.gif" width="12" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebagian masuk kembali ke siklus emerohepatik</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peningkatan bilirubin unconjugned dalam darah, pengeluaran meronium terlambat /obstruksi usus, tinja berwarna pucat</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span> <table align="left" cellpadding="0" cellspacing="0"><tbody>
<tr> <td height="2" width="374"><br />
</td> </tr>
<tr> <td><br />
</td> <td><img height="27" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image011.gif" width="12" /></td> </tr>
</tbody></table></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><br clear="ALL" style="color: #fff2cc;" /> <div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="height: 46px; left: 0px; margin-left: 397px; margin-top: 31px; position: absolute; width: 12px; z-index: 251678720;"><img height="46" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image012.gif" width="12" /></span><span style="height: 12px; left: 0px; margin-left: 262px; margin-top: 3px; position: absolute; width: 45px; z-index: 251660288;"><img height="12" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image013.gif" width="45" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">gangguan integtritas kulit<span> </span>Ikterus pada sclera leher dan badan peningkatan bilirubin indirex > 12 mg/dl</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 180pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Indikasi fototerapi</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span> <table align="left" cellpadding="0" cellspacing="0"><tbody>
<tr> <td height="2" width="385"><br />
</td> </tr>
<tr> <td><br />
</td> <td><img height="22" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image014.gif" width="12" /></td> </tr>
</tbody></table></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><br clear="ALL" style="color: #fff2cc;" /> <div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 216pt; text-align: justify;"><span style="height: 25px; left: 0px; margin-left: 390px; margin-top: 23px; position: absolute; width: 2px; z-index: 251665408;"><img height="25" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image015.gif" width="2" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sinar dengan Intensitas tinggi<span> </span></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span> <table align="left" cellpadding="0" cellspacing="0"><tbody>
<tr> <td height="18" width="337"><br />
</td> </tr>
<tr> <td><br />
</td> <td><img height="50" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image016.gif" width="99" /></td> </tr>
</tbody></table></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><br clear="ALL" style="color: #fff2cc;" /> <div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span><span> </span>Resti injuri<span> </span>Risiko kurang volume cairan</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi Klinis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kulit tampak berwarna kuning terang sampai jingga (pada bayi dengan bilirubin indirek)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Anemia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perbesaran lien dan hepar</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan tertutup</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan nafas</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan sirkulasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan saraf</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bilirubin encephahalopathi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kernikterus ; kerusakan neurologis ; cerebral palis, retardasi mental, hyperaktif, bicara lambat, tidak ada koordinat otot dan tangisan yangmelengking.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipotermi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipoglikemi</span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan Medis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berdasarkan pada penyebabnya, maka manejemen bayi dengan Hiperbilirubinemia diarahkan untuk mencegah anemia dan membatasi efek</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari Hiperbilirubinemia. </span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan mempunyai tujuan :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menghilangkan Anemia</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menghilangkan Antibodi Maternal dan Eritrosit Tersensitisasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan Badan Serum Albumin</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurunkan Serum Bilirubin</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Metode therapi pada Hiperbilirubinemia meliputi : Fototerapi, Transfusi Pengganti, Infus Albumin dan Therapi Obat.</span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fototherapi</span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fototherapi dapat digunakan sendiri atau dikombinasi dengan Transfusi Pengganti untuk menurunkan Bilirubin. Memaparkan neonatus padacahaya dengan intensitas yang tinggi ( a bound of fluorencent light bulbs orbulbs in the blue-light spectrum) akan menurunkan Bilirubin dalam kulit.Fototherapi menurunkan kadar Bilirubin dengan cara memfasilitasi eksresi Biliar Bilirubin tak terkonjugasi. Hal ini terjadi jika cahaya yang diabsorsijaringan mengubah Bilirubin tak terkonjugasi menjadi dua isomer yangdisebut Fotobilirubin. Fotobilirubin bergerak dari jaringan ke pembuluh darahmelalui mekanisme difusi. Di dalam darah Fotobilirubin berikatan dengan Albumin dan dikirim ke Hati. Fotobilirubin kemudian bergerak ke Empedu dan<span> </span>diekskresi ke dalam Deodenum untuk dibuang bersama feses tanpa proses konjugasi oleh Hati (Avery dan Taeusch, 1984). Hasil Fotodegradasi terbentuk ketika sinar mengoksidasi Bilirubin dapat dikeluarkan melalui urine.Fototherapi mempunyai peranan dalam pencegahan peningkatan kadar Bilirubin, tetapi tidak dapat mengubah penyebab Kekuningan dan Hemolisis dapat menyebabkan Anemia. </span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Secara umum Fototherapi harus diberikan pada kadar Bilirubin Indirek</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4 -5 mg / dl. Neonatus yang sakit dengan berat badan kurang dari 1000 gram</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">harus di Fototherapi dengan konsentrasi Bilirubun 5 mg / dl. Beberapa ilmuan mengarahkan untuk memberikan Fototherapi Propilaksis pada 24 jam pertama pada Bayi Resiko Tinggi dan Berat Badan Lahir Rendah.</span></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tranfusi Pengganti</span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Transfusi Pengganti atau Imediat diindikasikan adanya faktor-faktor :</span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Titer anti Rh lebih dari 1 : 16 pada ibu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit Hemolisis berat pada bayi baru lahir.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit Hemolisis pada bayi saat lahir perdarahan atau 24 jam pertama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tes Coombs Positif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kadar Bilirubin Direk lebih besar 3,5 mg / dl pada minggu pertama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Serum Bilirubin Indirek lebih dari 20 mg / dl pada 48 jam pertama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hemoglobin kurang dari 12 gr / dl.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi dengan Hidrops saat lahir.</span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi pada resiko terjadi Kern Ikterus.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Transfusi Pengganti digunakan untuk :</span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 67.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengatasi Anemia sel darah merah yang tidak Suseptible (rentan) terhadap sel darah merah terhadap Antibodi Maternal. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 67.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menghilangkan sel darah merah untuk yang Tersensitisasi (kepekaan).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 67.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menghilangkan Serum Bilirubin</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 67.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan Albumin bebas Bilirubin dan meningkatkan keterikatan dengan Bilirubin Pada Rh Inkomptabiliti diperlukan transfusi darah golongan O segera (kurang dari 2 hari), Rh negatif whole blood. Darah yang dipilih tidak mengandung antigen A dan antigen B yang pendek. setiap 4 - 8 jam kadar Bilirubin harus dicek. Hemoglobin harus diperiksa setiap hari sampai stabil.<span> </span></span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Therapi Obat</span></b></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Phenobarbital dapat menstimulasi hati untuk menghasilkan enzim</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yang meningkatkan konjugasi Bilirubin dan mengekresinya. Obat ini efektif</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">baik diberikan pada ibu hamil untuk beberapa hari sampai beberapa minggu</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sebelum melahirkan. Penggunaan penobarbital pada post natal masih menjadi pertentangan karena efek sampingnya (letargi). Colistrisin dapat mengurangi Bilirubin dengan mengeluarkannya lewat urine sehingga menurunkan siklus Enterohepatika.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span></div><b style="color: #fff2cc;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></b> <div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PROSES KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian </span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian yang dapat dilakukan oleh seorang perawat pada bayi dengan hiperbilirubinemia.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biodata bayi dan ibu, diantaranya nama, usia, jenis kelamin, pekerjaan, alamat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan keluarga</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit ini terjadi bisa dengan ibu dengan riwayat hiperbilirubinemia pada kehamilan atau sibling sebelumnya, penyakit hepar, fibrosiskistik, kesalahan metabolisme saat lahir (galaktosemia), diskrasiasi darah atau sfeosititas, dan definisi glukosa-6 fosfat dehidrogenase (G-6P).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan dahulu</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ibu dengan diabetes melitus, mengkonsumsi obat-obatan tertentu, misalnya salisilat, sulfonamidoral, pada rubella, sitomegalovirus pada proses persalinan dengan ekstraksi vakum, induksi, oksitoksin, dan perlambatan pengikatan tali pusat atau trauma kelahiran yang lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan sekarang</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi dengan kesadaran apatis, daya isap lemah atau bayi tak mau minum, hipotonia letargi, tangis yang melengking, dan mungkin terjadi kelumpuhan otot ekstravaskular.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan fisik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keadaan umum : lesu, letargi, koma.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda-tanda vital :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pernapasan : 40 kali per menit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nadi : 120-140 kali per menit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suhu : 36,5-37 <sup>o</sup>C.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesadaran apatis sampai koma.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Daerah kepala dan leher</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kulit kepala ada atau tidak terdapat bekas tindakan persalinan seperti : vakum atau terdapat kaput, sklera ikterik, muka kuning, leher kaku.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pernapasan </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat asfiksia, mukus, bercak merah (edema pleural, hemoragi pulmonal).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Abdomen</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada saat palpasi menunjukkan pembesaran limpa dan hepar, turgor buruk, bising usus hipoaktif.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Genitalia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak terdapat kelainan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>i)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Eliminasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Buang air besar (BAB): proses eliminasi mungkin lambat, feses lunak cokelat atau kehijauan, selama pengeluaran bilirubin. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Buang air kecil (BAK): urin berwarna gelap pekat, hitam kecokelatan (sindrom bayi Gronze).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>j)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ekstremitas</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tonus otot meningkat, dapat terjadi spasme otot dan epistotonus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>k)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem integumen</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terlihat joundice di seluruh permukaan kulit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis Keperawatan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko cedera berhubungan dengan kadar bilirubin darah toksik dan komplikasi berkenaan dengan fototerapi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko terhadap kekurangan volume cairan berhubungan dengan kehilangan cairan yang tidak tampak kasat mata serta dehidrasi dan fototerapi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan interaksi orang tua dan bayi berhubungan dengan fototerapi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana Intervensi</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis keperawatan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <b>1</b> : Risiko cedera berhubungan dengan kadar bilirubin darah toksik dan komplikasi berkenaan dengan fototerapi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Tidak terjadi cedera </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: kadar bilirubin indirek kurang dari 12 mg/dl pada bayi cukup bulan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><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></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perhatikan adanya perkembangan bilirubin dan obstruksi usus. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : pada kondisi ini kontraindikasi karena foto isomer bilirubin yang diproduksi dalam kulit dan jaringan subkutan dengan penajaman terapi sinar tidak siap dieksresikan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukur kuantitas fotoenergi bola lampu fluoresen dengan menggunakan fotometer.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : intensitas sinar yang menembus kulit dari spektrum biru (sinar biru) menentukan seberapa dekat bayi ditempatkan. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan penutup untuk menutup mata, inspeksi mata tiap 24 jam bila penutup mata dilepas untuk pemberian makanan, dan sering pantau potensi penutup mata.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : mencegah kemungkina kerusakan retina dan konjungtiva dari sinar intensitas tinggi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ubah posisi bayi dengan sering, sedikitnya setiap 2 jam.</span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: memungkinkan pemajanan seimbang dari permukaan kulit terhadap sinar fluoresensi serta mencegah pemajanan berlebihan dari bagian tubuh tertentu dan membatasi area tekanan.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis keperawatan 2</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : <span> </span>Risiko terhadap kekurangan volume cairan berhubungan dengan kehilangan cairan yang tidak tampak kasat mata serta dehidrasi dan fototerapi.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : tidak terjadi kekurangan volume cairan.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : berat badan tetap atau bertambah.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b><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></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Timbang berat badan bayi setiap hari tanpa pakaian dan timbang juga sebelum memberi makanan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : dengan menimbang BB bayi setiap hari dapat diketahui apakah terjadi kekurangan cairan tubuh atau tidak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau masukan dan pengeluaran cairan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: peningkatan kehilangan cairan melalui feses dan evaporasi dapat menyebabkan dehidrasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi pemberian cairan dengan parenteral sesuai dengan indikasi.</span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: pemberian cairan memperbaiki atau mencegah dehidrasi berat.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis keperawatan 3</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Gangguan interaksi orang tua dan bayi berhubungan dengan fototerapi.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:<span> </span>agar orang tua ikut berpartisipasi terhadap perkembangan kesehatan bayi.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b><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></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jelaskan perlunya memberi masukan cairan yang adekuat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: mencegah kekurangan cairan tubuh.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan orang tua berpartisipasi dalam perawatan bayi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: mempererat hubungan orang tua dan bayi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinjau ulang perawatan bayi dengan hiperbilirubinemia.</span></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: mengecek perkembangan kadar bilirubin.</span></div><b style="color: #fff2cc;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></b><br style="color: #fff2cc;" /> <div align="center" class="MsoNormal" style="color: #fff2cc; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">BAB IV</span></b></div><div align="center" class="MsoNormal" style="color: #fff2cc; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">PENUTUP</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; margin-bottom: 0.0001pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kesimpulan </span></b></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Hiperbilirubinemia adalah berlebihnya akumulasi bilirubin dalam darah (level normal 5 mg/dl pada bayi normal) yang mengakibatkan jaundice, warna kuning yang terlihat jelas pada kulit, mukosa, sklera dan urine.<span> </span></span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hiperbilirubinemia</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah suatu keadaan dimana kadar Bilirubin dalam darah mencapai suatu nilai yang mempunyai potensi untuk menimbulkan Kern Ikterus kalau tidak ditanggulangi dengan baik, atau mempunyai hubungan dengan keadaan yang patologis. Brown menetapkan Hiperbilirubinemia bila kadar Bilirubin mencapai 12 mg% pada cukup bulan, dan 15 mg % pada bayi kurang bulan. Utelly menetapkan 10 mg% dan 15 mg%.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus pada neonatus tidak selamanya patologis. Terdapat tiga jenis ikterus, yaitu:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus fisiologis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ikterus Patologis / Hiperbilirubinemia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kern Ikterus</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fff2cc; margin-bottom: 0.0001pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Saran</span></b></div><div class="MsoListParagraphCxSpLast" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kami selaku penulis berharap kepada pembaca khususnya kami sendiri agar dapat meningkatkan lagi ilmu pengetahuan dan keterampilan yang dimiliki dibidang<span> </span>mata kuliah maternitas khususnya terkait asuhan keperawatan pada klien dengan hiperbilirubinemia.<span> </span></span></div><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: #fff2cc; line-height: 200%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">DAFTAR PUSTAKA</span></b></div><div class="MsoListParagraph" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";"><a href="http://botol-infus.blogspot.com/2010/01/askep-hiperbilirubinemia.html"><span style="font-size: 12pt; line-height: 150%;">http://botol-infus.blogspot.com/2010/01/askep-hiperbilirubinemia.html</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. (Diakses tanggal 11 Januari 2011)Mitayani. 2009. <i>Asuhan Keperawatan Maternitas</i>. Jakarta: Salemba Medika.</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://duta4diagnosaanak.blogspot.com/2010/06/asuhan-keperawatan-anak-hiperbilirubin.html . (Diakses tanggal 11 Januari 2011)</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://library.usu.ac.id/download/fk/keperawatan-mula%20tarigan.pdf. (Diakses tanggal 11 Januari 2011)</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://www.foxitsoftware.com For evaluation only. (Diakses tanggal 11 Januari 2011)</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif";"><a href="http://www.trinoval.web.id/2010/04/askep-hiperbilirubin.html"><span style="font-size: 12pt; line-height: 150%;">http://www.trinoval.web.id/2010/04/askep-hiperbilirubin.html</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. (Diakses tanggal 11 Januari 2011)</span></div><div class="MsoNormal" style="color: #fff2cc; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Staf Pengajar Ilmu Kesehatan Anak. 1985. <i>Buku Kuliah 3 Ilmu Kesehatan Anak</i>.<span> </span>Jakarta:<span> </span>Fakultas Kedokteran Universitas Indonesia.</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-50154276788440183602011-02-22T16:42:00.000-08:002011-02-22T16:42:54.402-08:00Askep Post Partum Blues<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><b>BAB I<br />
PENDAHULUAN</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><strong>Latar Belakang</strong></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Kehamilan merupakan episode dramatis terhadap kondisi biologis, perubahan psikologis dan adaptasi dari seorang wanita yang pernah mengalaminya. Sebagian besar kaum wanita menganggap bahwa kehamilan adalah peristiwa kodrati yang harus dilalui tetapi sebagian wanita mengganggap sebagai peristiwa khusus yang sangat menentukan kehidupan selanjutnya. Perubahan fisik dan emisional yang kompleks, memerlukan adaptasi terhadap penyesuaian pola hidup dengan proses kehamilan yang terjadi. Konflik antara keinginan prokreasi, kebanggaan yang ditumbuhkan dari norma-norma sosial cultural dan persoalan dalam kehamilan itu sendiri dapat merupakan pencetus berbagai reaksi psikologis, mulai dari reaksi emosional ringan hingga ke tingkat gangguan jiwa yang berat.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Masa nifas adalah suatu masa dimana tubuh menyesuaikan baik fisik maupun psikologis terhadap proses melahirkan yang lamanya kurang lebih 6 minggu. Selain itu pengertian masa nifas adalah masa mulainya persalinan sampai pulihnya alat-alat dan anggota badan yang berhubungan dengan kehamilan/persalinan (Ahmad Ramli. 1989). Dari dua pengertian di atas kelompok meyimpulkan bahwa masa nifas adalah masa sejak selesainya persalinan hingga pulihnya alat-alat kandungan dan anggota badan serta psikososial yang berhubungan dengan kehamilan/persalinan selama 6 minggu. Dalam proses adaptasi pada masa postpartum terdapat tiga metode yang meliputi ”immediate puerperineum” yaitu 24 jam pertama setelah melahirkan, ”early puerperineum” yaitu setelah 24 jam hingga 1 minggu, dan ”late puerperineum” yaitu setelah satu minggu sampai 6 minggu postpartum.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Perubahan psikologi pascapartum pada seorang ibu yang baru melahirkan terbagi dalam tiga fase:</div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">taking in</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dimana pada fase ini ibu ingin merawat dirinya sendiri, banyak bertanya dan bercerita tentang pengalamannya selama persalinan yang berlangsung 1 sampai 2 hari.</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">taking hold </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dimana pada fase ini ibu mulai fokus dengan bayinya yang berlangsung 4 sampai 5 minggu.</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">fase letting-go</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dimana ibu mempunyai persepsi bahwa bayinya adalah perluasan dari dirinya, mulai fokus kembali pada pasangannya dan kembali bekerja mengurus hal-hal lain. </span></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Perubahan tersebut merupakan perubahan psikologi yang normal terjadi pada seorang ibu yang baru melahirkan. Namun, kadang-kadang terjadi perubahan psikologi yang abnormal. Gangguan psikologi pascapartum dibagi menjadi tiga kategori yaitu postpartum blues atau kesedihan pascapartum, depresi pascapartum nonpsikosis, dan psikosis pascapartum. Pada makalah ini kami akan membahas secara khusus mengenai post partum blues. Beberapa penyesuaian dibutuhkan oleh wanita dalam menghadapi aktivitas dan peran barunya sebagai ibu pada minggu-minggu atau bulan-bulan pertama setelah melahirkan, baik dari segi fisik maupun segi psikologis. Sebagian wanita berhasil menyesuaikan diri dengan baik, tetapi sebagian lainnya tidak berhasil menyesuaikan diri dan mengalami gangguan-gangguan psikologis dengan berbagai gejala atau sindroma yang oleh para peneliti dan klinisi disebut post-partum blues. </div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Tujuan</b></div><div class="MsoListParagraphCxSpFirst" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Umum </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui dan memahami lebih dalam lagi yang dimaksud dengan gangguan psikologis pada ibu masa postpartum khusunya post partum Blues. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Khusus </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui dan memahami definisi, epidemiologi, etiologi, patogenesis, gambaran klinis, diagnosis, penatalaksanaan dan Asuhan keperawatan pada Gangguan psikologis ibu postpartum. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan kemampuan dalam penulisan asuhan keperawatan. </span></div><div class="MsoListParagraphCxSpLast" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memenuhi salah satu tugas perkuliahan Keperawatan Maternitas. </span></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Rumusan Masalah</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Masalah yang timbul kemudian yaitu : apa itu postpartum blues?, bagaimana epidemiologinya, etiologi, pathogenesis, gambaran klinis, pemeriksaan penunjang, penatalaksanaan serta bagaimana dengan asuhan keperawatannya? 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</div><div align="center" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><b>BAB II</b></div><div align="center" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><b>ASUHAN KEPERAWATAN PADA IBU DENGAN<br />
GANGGUAN PSIKOLOGIS POSTPARTUM : POSTPARTUM BLUES</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Konsep Dasar</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Pengertian</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Post-partum blues sendiri sudah dikenal sejak lama. Savage pada tahun 1875 telah menulis referensi di literature kedokteran mengenai suatu keadaan disforia ringan pasca-salin yang disebut sebagai ‘milk fever ‘ karena gejala<br />
disforia tersebut muncul bersamaan dengan laktasi. Dewasa ini, post-partum blues (PPB) atau sering juga disebut maternity blues atau baby blues dimengerti sebagai suatu sindroma gangguan afek ringan yang sering tampak dalam minggu pertama setelah persalinan atau pada saat fase taking in, cenderung akan memburuk pada hari ketiga sampai kelima dan berlangsung dalam rentang waktu 14 hari atau dua minggu pasca persalinan. Post-partum blues ini dikategorikan sebagai sindroma gangguan mental yang ringan oleh sebab itu sering tidak dipedulikan sehingga tidak terdiagnosis dan tidak ditatalaksanai sebagaimana seharusnya, akhirnya dapat menjadi masalah yang menyulitkan, tidak menyenangkan dan dapat membuat perasaan-perasaan tidak nyaman bagi wanita yang mengalaminya, dan bahkan kadang-kadang gangguan ini dapat berkembang menjadi keadaan yang lebih berat yaitu depresi dan psikosis pasca-salin, yang mempunyai dampak lebih buruk, terutama dalam masalah hubungan perkawinan dengan suami dan perkembangan anak, karena stres dan sikap ibu yang tidak tulus terus-menerus bisa membuat bayi tumbuh menjadi anak yang mudah menangis, cenderung rewel, pencemas, pemurung dan mudah sakit. Keadaan ini sering disebut puerperium atau trimester keempat kehamilan. Baby blues adalah keadaan di mana seorang ibu mengalami perasaan tidak nyaman (kesedihan atau kemurungan)/gangguan suasana hati setelah persalinan, yang berkaitan dengan hubungannya dengan si bayi, atau pun dengan dirinya sendiri. Ketika plasenta dikeluarkan pada saat persalinan, terjadi perubahan hormon yang melibatkan endorphin, progesteron, dan estrogen dalam tubuh Ibu, yang dapat mempengaruhi kondisi fisik, mental dan emosional Ibu. </div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Etiologi</b></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi atau penyebab pasti terjadinya postpartum blues sampai saat ini belum diketahui. Namun, banyak faktor yang diduga berperan terhadap terjadinya postpartum blues, antara lain:</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor hormonal yang berhubungan dengan perubahan kadar estrogen, progesteron, prolaktin dan estradiol. Penurunan kadar estrogen setelah melahirkan sangat berpengaruh pada gangguan emosional pascapartum karena estrogen memiliki efek supresi aktifitas enzim monoamine oksidase yaitu suatu enzim otak yang bekerja menginaktifasi noradrenalin dan serotonin yang berperan dalam perubahan mood dan kejadian depresi.</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor demografi yaitu umur dan paritas.</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengalaman dalam proses kehamilan dan persalinan.</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar belakang psikososial ibu, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">seperti; tingkat pendidikan, status perkawinan, kehamilan yang tidak diinginkan, riwayat gangguan kejiwaan sebelumnya, sosial ekonomi serta keadekuatan dukungan sosial dari lingkungannya (suami, keluarga dan teman). Apakah suami menginginkan juga kehamilan ini, apakah suami, keluarga, dan teman memberi dukungan moril (misalnya dengan membantu pekerjaan rumah tangga, atau berperan sebagai tempat ibu mengadu/berkeluh-kesah) selama ibu menjalani masa kehamilannya atau timbul permasalahan, misalnya suami yang tidak membantu, tidak mau mengerti perasaan istri maupun persoalan lainnya dengan suami, problem dengan orang tua dan mertua, problem dengan si sulung.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Takut kehilangan bayinya atau kecewa dengan bayinya.</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Namun ada beberapa pendapat yang menyebutkan bahwa </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Post partum blues tidak berhubungan dengan perubahan hormonal, biokimia atau kekurangan gizi. Antara 8% sampai 12% wanita tidak dapat menyesuaikan peran sebagai orang tua dan menjadi sangat tertekan sehingga mencari bantuan dokter. Dengan kata lain para wanita lebih mungkin mengembangkan depresi post partum jika mereka terisolasi secara sosial dan emosional serta baru saja mengalami peristiwa kehidupan yang menakan.</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada juga yang berpendapat bahwa kemunculan dari postpartum blues ini disebabkan oleh beberapa factor dari dalam dan luar individu. Penelitian dari Dirksen dan De Jonge Andriaansen (1985) menunjukkan bahwa depresi tersebut membawa kondisi yang berbahaya bagi perkembangan anak di kemudian hari. De Jonge Andriaansen juga meneliti beberapa teknologi medis (penggunaan alat-alat obstetrical) dalam pertolongan melahirkan dapat memicu depresi postpartum blues ini. Misalnya saja pada pembedahan caesar, penggunaan tang, tusuk punggung, </span><a href=""><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">episiotomi</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dan sebagainya. Perubahan hormon dan perubahan hidup ibu pasca melahirkan juga dapat dianggap pemicu.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Manifestasi Klinis</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Gejala-gejala postpartum blues ini bisa terlihat dari perubahan sikap seorang ibu. Gejala tersebut biasanya muncul pada hari ke-3 atau 6 hari setelah melahirkan. Beberapa perubahan sikap tersebut diantaranya sering tiba-tiba menangis karena merasa tidak bahagia, penakut, tidak mau makan, tidak mau bicara, sakit kepala sering berganti mood, mudah tersinggung (iritabilitas), merasa terlalu sensitif dan cemas berlebihan, tidak bergairah, khususnya terhadap hal yang semula sangat diminati, tidak mampu berkonsentrasi dan sangat sulit membuat keputusan, merasa tidak mempunyai ikatan batin dengan si kecil yang baru saja Anda lahirkan , insomnia yang berlebihan. Gejala-gejala itu mulai muncul setelah persalinan dan pada umumnya akan menghilang dalam waktu antara beberapa jam sampai beberapa hari. Namun jika masih berlangsung beberapa minggu atau beberapa bulan itu dapat disebut postpartum depression. </div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Insiden</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Dalam dekade terakhir ini, banyak peneliti dan klinisi yang memberi perhatian khusus pada gejala psikologis yang menyertai seorang wanita pasca salin, dan telah melaporkan beberapa angka kejadian dan berbagai faktor yang diduga mempunyai kaitan dengan gejala-gejala tersebut. Berbagai studi mengenai post-partum blues di luar negeri melaporkan angka kejadian yang cukup tinggi dan sangat bervariasi antara 26-85%, yang kemungkinan disebabkan karena adanya perbedaan populasi dan kriteria diagnosis yang digunakan. </div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Pencegahan</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;">Post partum blues dapat dicegah dengan cara :</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Anjurkan ibu untuk merawat dirinya, yakinkan pada suami atau keluarga untuk selalu memperhatikan si ibu</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Menu makanan yang seimbang</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Olah raga secara teratur</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Mintalah bantuan pada keluarga atau suami untuk merawat ibu dan bayinya.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Rencanakan acara keluar bersama bayi berdua dengan suami</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Rekreasi</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Pemeriksaan Diagnostik</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Sampai saat ini belum ada alat test khusus yang dapat mendiagnosa secara langsung post partum blues. Secara medis, dokter menyimpulkan beberapa simtom yang tampak dapat disimpulkan sebagai gangguan depresi post partum blues bila memenuhi kriteria gejala yang ada. Kekurangan hormon tyroid yang ditemukan pada individu yang mengalami kelelahan luar biasa (fatigue) ditemukan juga pada ibu yang mengalami post partum blues mempunyai jumlah kadar tyroid yang sangat rendah.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Skrining untuk mendeteksi gangguan mood/depresi sudah merupakan acuan pelayanan pasca salin yang rutin dilakukan. Untuk skrining ini dapat dipergunakan beberapa kuesioner dengan sebagai alat bantu. Endinburgh Posnatal Depression Scale (EPDS) merupakan kuesioner dengan validitas yang teruji yang dapat mengukur intensitas perubahan perasaan depresi selama 7 hari pasca salin. Pertanyaan-pertanyaannya berhubungan dengan labilitas perasaan, kecemasan, perasaan bersalah serta mencakup hal-hal lain yang terdapat pada post-partum blues . Kuesioner ini terdiri dari 10 (sepuluh) pertanyaan, di mana setiap pertanyaan memiliki 4 (empat) pilihan jawaban yang mempunyai nilai skor dan harus dipilih satu sesuai dengan gradasi perasaan yang dirasakan ibu pasca salin saat itu. Pertanyaan harus dijawab sendiri oleh ibu dan rata-rata dapat diselesaikan dalam waktu 5 menit. Cox et. Al., mendapati bahwa nilai skoring lebih besar dari 12 (dua belas) memiliki sensitifitas 86% dan nilai prediksi positif 73% untuk mendiagnosis kejadian post-partum blues . EPDS juga telah teruji validitasnya di beberapa negara seperti Belanda, Swedia, Australia, Italia, dan Indonesia. EPDS dapat dipergunakan dalam minggu pertama pasca salin dan bila hasilnya meragukan dapat diulangi pengisiannya 2 (dua) minggu kemudian.<b> </b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Penatalaksanaan</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Post-partum blues atau gangguan mental pasca-salin seringkali terabaikan dan tidak ditangani dengan baik. Banyak ibu yang ‘berjuang’ sendiri dalam beberapa saat setelah melahirkan. Mereka merasakan ada suatu hal yang salah namun mereka sendiri tidak benar-benar mengetahui apa yang sedang terjadi. Apabila mereka pergi mengunjungi dokter atau sumber-sumber lainnya Untuk minta pertolongan, seringkali hanya mendapatkan saran untuk beristirahat atau tidur lebih banyak, tidak gelisah, minum obat atau berhenti mengasihani diri sendiri dan mulai merasa gembira menyambut kedatangan bayi yang mereka cintai.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Penanganan gangguan mental pasca-salin pada prinsipnya tidak berbeda dengan penanganan gangguan mental pada momen-momen lainya. Para ibu yang mengalami post-partum blues membutuhkan pertolongan yang sesungguhnya. Para ibu ini membutuhkan dukungan pertolongan yang sesungguhnya. Para ibu ini membutuhkan dukungan psikologis seperti juga kebutuhan fisik lainnya yang harus juga dipenuhi. Mereka membutuhkan kesempatan untuk mengekspresikan pikiran dan perasaan mereka dari situasi yang menakutkan. Mungkin juga mereka membutuhkan pengobatan dan/atau istirahat, dan seringkali akan merasa gembira mendapat pertolongan yang praktis. Dengan bantuan dari teman dan keluarga, mereka mungkin perlu untuk mengatur atau menata kembali kegiatan rutin sehari-hari, atau mungkin menghilangkan beberapa kegiatan, disesuaikan dengan konsep mereka tentang keibuan dan perawatan bayi. Bila memang diperlukan, dapat diberikan pertolongan dari para ahli, misalnya dari seorang psikolog atau konselor yang berpengalaman dalam bidang tersebut.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Para ahli obstetri memegang peranan penting untuk mempersiapkan para wanita untuk kemungkinan terjadinya gangguan mental pasca-salin dan segera memberikan penanganan yang tepat bila terjadi gangguan tersebut, bahkan merujuk para ahli psikologi/konseling bila memang diperlukan. Dukungan yang memadai dari para petugas obstetri, yaitu: dokter dan bidan/perawat sangat diperlukan, misalnya dengan cara memberikan informasi yang memadai/adekuat tentang proses kehamilan dan persalinan, termasuk penyulit-penyulit yang mungkin timbul dalam masa-masa tersebut serta penanganannya.<br />
Post-partum blues juga dapat dikurangi dengan cara belajar tenang dengan menarik nafas panjang dan meditasi, tidur ketika bayi tidur, berolahraga ringan, ikhlas dan tulus dengan peran baru sebagai ibu, tidak perfeksionis dalam hal mengurusi bayi, membicarakan rasa cemas dan mengkomunikasikannya, bersikap fleksibel, bergabung dengan kelompok ibu-ibu baru. Dalam penanganan para ibu yang mengalami post-partum blues dibutuhkan pendekatan menyeluruh/holistik. Pengobatan medis, konseling emosional, bantuan-bantuan praktis dan pemahaman secara intelektual tentang pengalaman dan harapan-harapan mereka mungkin pada saat-saat tertentu. Secara garis besar dapat dikatakan bahwa dibutuhkan penanganan di tingkat perilaku, emosional, intelektual, sosial dan psikologis secara bersama-sama, dengan melibatkan lingkungannya, yaitu: suami, keluarga dan juga teman dekatnya. </div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Konsep Asuhan Keperawatan</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Pengkajian</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Pengenalan gejala mood merupakan hal yang penting untuk dilakukan oleh perawat perinatal. Rencana keperawatan harus merefleksikan respons perilaku yang diharapkan dari gangguan tertentu. Rencan individu didasarkan pada karakteristik wanita dan keadaannya yang spesifik. Suami atau pasangan wanita tersebut juga dapat mengalami gangguan emosional akibat perilaku wanita tersebut.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Pengkajian pada pasien post partum blues menurut Bobak ( 2004 ) dapat dilakukan pada pasien dalam beradaptasi menjadi orang tua baru. Pengkajiannya meliputi ;</div><div class="MsoListParagraphCxSpFirst" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas klien</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data diri klien meliputi : nama, umur, pekerjaan, pendidikan, alamat, medical record dan lain-lain</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dampak pengalaman melahirkan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Banyak ibu memperlihatkan suatu kebutuhan untuk memeriksa proses kelahiran itu sendiri dan melihat kembali perilaku mereka saat hamil dalam upaya retrospeksi diri (Konrad, 1987). Selama hamil, ibu dan pasangannya mungkin telah membuat suatu rencana tertentu tentang kelahiran anak mereka, hal-hal yang mencakup kelahiran pervagina dan beberapa intervensi medis. Apabila pengalaman mereka dalam persalinan sangat berbeda dari yang diharapkan (misalnya ; induksi, anestesi epidural, kelahiran sesar), orang tua bisa merasa kecewa karena tidak bisa mencapai yang telah direncanakan sebelumnya. Apa yang dirasakan orang tua tentang pengalaman melahirkan sudah pasti akan mempengaruhi adaptasi mereka untuk menjadi orang tua.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Citra diri ibu</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suatu pengkajian penting mengenai konsep diri, citra tubuh, dan seksualitas ibu. Bagaimana perasaan ibu baru tentang diri dan tubuhnya selama masa nifas dapat mempengaruhi perilaku dan adaptasinya dalam menjadi orang tua. Konsep diri dan citra tubuh ibu juga dapat mempengaruhi seksualitasnya. Perasaan-perasaan yang berkaitan dengan penyesuaian perilaku seksual setelah melahirkan seringkali menimbulkan kekhawatiran pada orang tua baru. Ibu yang baru melahirkan bisa merasa enggan untuk memulai hubungan seksual karena takut merasa nyeri atau takut bahwa hubungan seksual akan mengganggu penyembuhan jaringan perineum.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Interaksi Orang tua – Bayi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suatu pengkajian pada masa nifas yang menyeluruh meliputi evaluasi interaksi orang tua dengan bayi baru. Respon orang tua terhadap kelahiran anak meliputi perilaku adaptif dan perilaku maladatif. Baik ibu maupun ayah menunjukkan kedua jenis perilaku maupun saat ini kebanyakan riset hanya berfokus pada ibu. Banyak orang tua baru mengalami kesulitan untuk menjadi orang tua sampai akhirnya keterampilan mereka membaik. Kualitas keibuan atau kebapaan pada perilaku orang tua membantu perawatan dan perlindungan anak. Tanda-tanda yang menunjukkan ada atau tidaknya kualitas ini, terlihat segera setelah ibu melahirkan, saat orang tua bereaksi terhadap bayi baru lahir dan melanjutkan proses untuk menegakkan hubungan mereka.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perilaku Adaptif dan Perilaku Maladaptif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perilaku adaptif berasal dari penerimaan dan persepsi realistis orang tua terhadap kebutuhan bayinya yang baru lahir dan keterbatasan kemampuan mereka, respon social yang tidak matur, dan ketidakberdayaannya. Orang tua menunjukkan perilaku yang adaptif ketika mereka merasakan suka cita karena kehadiran bayinya dan karena tugas-tugas yang diselesaikan untuk dan bersama anaknya, saat mereka memahami yang dikatakan bayinya melalui ekspresi emosi yang diperlihatkan bayi dan yang kemudian menenangkan bayinya, dan ketika mereka dapat membaca gerakan bayi dan dapat merasa tingkat kelelahan bayi. Perilaku maladaptif terlihat ketika respon orang tua tidak sesuai dengan kebutuhan bayinya. Mereka tidak dapat merasakan kesenangan dari kontak fisik dengan anak mereka. Bayi – bayi ini cenderung akan dapat diperlakukan kasar. Orang tua tidak merasa tertarik untuk melihat anaknya. Tugas merawat anak seperti memandikan atau mengganti pakaian, dipandang sebagai sesuatu yang menyebalkan. Orang tua tidak mampu membedakan cara berespon terhadap tanda yang disampaikan oleh bayi, seperti rasa lapar, lelah keinginan untuk berbicara dan kebutuhan untuk dipeluk dan melakukan kontak mata. Tampaknya sukar bagi mereka untuk menerima anaknya sebagai anak yang sehat dan gembira.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Struktur dan fungsi keluarga</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komponen penting lain dalam pengkajian pada pasien post partum blues ialah melihat komposisi dan fungsi keluarga. Penyesuaian seorang wanita terhadap perannya sebagai ibu sangat dipengaruhi oleh hubungannya dengan pasangannya, ibunya dengan keluarga lain, dan anak-anak lain. Perawat dapat membantu meringankan tugas ibu baru yang akan pulang dengan mengkaji kemungkinan konflik yang bisa terjadi diantara anggota keluarga dan membantu ibu merencanakan strategi untuk mengatasi masalah tersebut sebelum keluar dari rumah sakit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sedangkan Pengkajian Dasar data klien menurut Marilynn E. Doenges ( 2001 ) Adalah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aktivitas / istirahat Insomnia mungkin teramati.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirkulasi<br />
Episode diaforetik lebih sering terjadi pada malam hari.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Integritas Ego</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peka rangsang, takut/menangis (" Post partum blues " sering terlihat kira-kira 3 hari setelah kelahiran).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Eliminasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diuresis diantara hari ke-2 dan ke-5.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Makanan/cairan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kehilangan nafsu makan mungkin dikeluhkan mungkin hari – hari ke-3.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri/ketidaknyamanan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri tekan payudara/pembesaran dapat terjadi diantara hari ke-3 sampai ke-5 pascapartum.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Seksualitas</span></div><div class="MsoListParagraphCxSpLast" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Uterus 1 cm diatas umbilikus pada 12 jam setelah kelahiran, menurun kira-kira 1 lebar jari setiap harinya. Lokhia rubra berlanjut sampai hari ke-2- 3, berlanjut menjadi lokhia serosa dengan aliran tergantung pada posisi (misalnya ; rekumben versus ambulasi berdiri) dan aktivitas (misalnya ; menyusui). Payudara : Produksi kolostrum 48 jam pertama, berlanjut pada susu matur, biasanya pada hari ke-3; mungkin lebih dini, tergantung kapan menyusui dimulai.</span></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Diagnosa Keperawatan</b></div><div class="MsoListParagraphCxSpFirst" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa keperawatan pada pasien postpartum blues diantaranya Adalah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri akut/ketidaknyamanan berhubungan dengan trauma mekanis, edema/pembesaran jaringan atau distensi, efek-efek hormonal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menyusui berhubungan dengan tingkat pengetahuan, pengalaman<br />
sebelumnya, usia gestasi bayi, tingkat dukungan, struktur/karakteristik fisik payudara ibu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko tinggi terhadap perubahan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peran</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> menjadi orang tua berhubungan dengan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengaruh komplikasi fisik dan emosional</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi ketidakefektifan koping individu berkaitan perubahan emosional yang tidak stabil pada ibu</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pola tidur berhubungan dengan Respon hormonal dan<br />
psikologis (sangat gembira, ansietas, kegirangan), nyeri/ketidaknyamanan, proses persalinan dan kelahiran melelahkan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurang pengetahuan mengenai perawatan diri dan perawatan bayi<br />
berhubungan dengan kurang pemajanan / mengingat, kesalahan interpretasi, tidak mengenal sumber – sumber.</span></div><div class="MsoListParagraphCxSpLast" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Potensial terhadap pertumbuhan koping keluarga berhubungan dengan<br />
kecukupan pemenuhan kebutuhan – kebutuhan individu dan tugas – tugas adaptif, memungkinkan tujuan aktualisasi diri muncul ke permukaan.</span></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Rencana Keperawatan</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><b><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><i>Nyeri akut/ketidaknyamanan berhubungan dengan trauma mekanis, edema/pembesaran jaringan atau distensi, efek-efek hormonal.</i><br />
<b>Tujuan :</b> Mengidentifikasi dan menggunakan intervensi untuk mengatasi<br />
ketidaknyamanan.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;"><b>Intervensi Keperawatan :</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tentukan adanya, lokasi, dan sifat ketidaknyamanan.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Mengidentifikasi kebutuhan – kebutuhan khusus dan intervensi yang tepat.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Inspeksi perbaikan perineum dan epiostomi.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Dapat menunjukkan trauma berlebihan pada jaringan perineal dan terjadinya komplikasi yang memerlukan evaluasi / intervensi lanjut.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Berikan kompres es pada perineum, khususnya selama 24 jam pertama setelah kelahiran.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Memberi anestesia lokal, meningkatkan vasokonstriksi, dan mengurangi edema dan vasodilatasi.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Berikan kompres panas lembab (misalnya ; rendam duduk / bak mandi)</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Meningkatkan sirkulasi pada perineum, meningkatkan oksigenasi dan nutrisi pada jaringan, menurunkan edema dan meningkatkan penyembuhan.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Anjurkan duduk dengan otot gluteal terkontraksi diatas perbaikan episiotomy.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Penggunaan pengencangan gluteal saat duduk menurunkan stres dan tekanan langsung pada perineum.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kolaborasi dalam pemberian obat analgesik 30-60 menit sebelum menyusui.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Memberikan kenyamanan, khususnya selama laktasi, bila afterpain paling hebat karena pelepasan oksitosin.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><b><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b>Menyusui berhubungan dengan tingkat pengetahuan, pengalaman<br />
sebelumnya, usia gestasi bayi, tingkat dukungan, struktur/karakteristik fisik payudara ibu.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;"><b>Tujuan :</b> Mengungkapkan pemahaman tentang proses/situasi menyusui, mendemonstrasikan teknik efektif dari menyusui, menunjukkan kepuasan regimen menyusui satu sama lain.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;"><b>Intervensi Keperawatan :</b></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kaji pengetahuan dan pengalaman klien tentang menyusui sebelumnya<br />
Rasional : Membantu dalam mengidentifikasi kebutuhan saat ini dan mengembangkan rencana perawatan.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tentukan sistem pendukung yang tersedia pada klien, dan sikap pasangan / keluarga.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Mempunyai dukungan yang cukup meningkatkan kesempatan untuk pengalaman menyusui dengan berhasil.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Berikan informasi, verbal dan tertulis, mengenai fisiologi dan keuntungan menyusui, perawatan putting dan payudara, kebutuhan diet khusus, dan faktor–faktor yang memudahkan atau mengganggu keberhasilan menyusui.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Membantu menjamin supli susu adekuat, mencegah putting pecah dan luka, memberikan kenyamanan, dan membuat peran ibu menyusui.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Demonstrasikan dan tinjau ulang teknik – teknik menyusui</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Posisi yang tepat biasanya mencegah luka putting, tanpa memperhatikan lamanya menyusu.</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Identifikasi sumber-sumber yang tersedia di masyarakat sesuai indikasi ; misalnya ; progam Kesehatan Ibu dan Anak ( KIA ).</div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify;">Rasional : Pelayanan ini mendukung pemberian ASI melalui pendidikan klien dan nutrisional.</div><div class="MsoListParagraphCxSpFirst" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i></b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko tinggi terhadap perubahan </span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peran</span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> menjadi orang tua berhubungan dengan </span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengaruh komplikasi fisik dan emosional</span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></i></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengungkapkan masalah dan pertanyaan tentang menjadi orang tua, mendiskusikan peran menjadi orang tua secara realistis, secara aktif mulai melakukan tugas perawatan bayi baru lahir dengan tepat, mengidentifikasi sumber-sumber.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi Keperawatan :</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji kekuatan, kelemahan, usia, status perkawinan, ketersediaan sumber pendukung dan latar belakang budaya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Mengidentifikasi faktor – faktor risiko potensial dan sumber-sumber pendukung, yang mempengaruhi kemampuan klien/pasangan untuk menerima tantangan peran menjadi orang tua.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perhatikan respons klien/pasangan terhadap kelahiran dan peran menjadi orang tua.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Kemampuan klien untuk beradaptasi secara positif untuk menjadi orang tua mungkin dipengaruhi oleh reaksi ayah dengan kuat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi sifat dari menjadi orangtua secara emosi dan fisik yang pernah dialami klien/pengalaman selama kanak-kanak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Peran menjadi orang tua dipelajari, dan individu memakai peran orang tua mereka sendiri menjadi model peran.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinjau ulang catatan intrapartum terhadap lamanya persalinan, adanya komplikasi, dan peran pasangan pada persalinan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Persalinan lama dan sulit, dapat secara sementara menurunkan energi fisik dan emosional yang perlu untuk mempelajari peran menjadi ibu dan dapat secara negatif mempengaruhi menyusui.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi status fisik masa lalu dan saat ini dan kejadian komplikasi pranatal, intranatal, atau pascapartal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Kejadian seperti persalinan praterm, hemoragi, infeksi, atau adanya komplikasi ibu dapat mempengaruhi kondisi psikologis klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi kondisi bayi ; komunikasikan dengan staf perawatan sesuai indikasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Ibu sering mengalami kesedihan karena mendapati bayinya tidak seperti bayi yang diharapkan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau dan dokumentasikan interaksi klien/pasangan dengan bayi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Beberapa ibu atau ayah mengalami kasih sayang bermakna pada pertama kali ; selanjutnya, mereka dikenalkan pada bayi secara bertahap.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan pasangan/sibling untuk mengunjungi dan menggendong bayi dan berpartisipasi terhadap aktifitas perawatan bayi sesuai izin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Membantu meningkatkan ikatan dan mencegah perasaan putus asa.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam merujuk untuk konseling bila keluarga beresiko tinggi terhadap masalah menjadi orang tua atau bila ikatan positif diantara klien/pasangan dan bayi tidak terjadi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Perilaku menjadi orang tua yang negatif dan ketidakefektifan koping memerlukan perbaikan melalui konseling, pemeliharaan atau bahkan psikoterapi yang lama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i></b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko tidak efektif koping individual berhubungan dengan krisis<br />
maturasional dari kehamilan/mengasuh anak dan melakukan peran ibu dan menjadi orang tua (atau melepaskan untuk adopsi), kerentanan personal, ketidakadekuatan sistem pendukung, persepsi tidak realistis</span></i></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengungkapkan ansietas dan respon emosional, mengidentifikasi kekuatan individu dan kemampuan koping pribadi, mencari sumber-sumber yang tepat sesuai kebuuhan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi Keperawatan :</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji respon emosional klien selama pranatal dan dan periode intrapartum dan persepsi klien tentang penampilannya selama persalinan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Terhadap hubungan langsung antara penerimaan yang positif akan peran feminin dan keunikan fungsi feminin serta adaptasi yang positif terhadap kelahiran anak, menjadi ibu, dan menyusui.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan diskusi oleh klien / pasangan tentang persepsi pengalaman kelahiran.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Membantu klien / pasangan bekerja melalui proses dan memperjelas realitas dari pengalaman fantasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji terhadap gejala depresi yang fana (" perasaan sedih " pascapartum) pada hari ke-2 sampai ke-3 pascapartum (misalnya ; ansietas, menangis, kesedihan, konsentrasi yang buruk, dan depresi ringan atau berat).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Sebanyak 80 % ibu – ibu mengalami depresi sementara atau perasaan emosi kecewa setelah melahirkan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi kemampuan koping masa lalu klien, latar belakang budaya, sistem pendukung, dan rencana untuk bantuan domestik pada saat pulang.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Membantu dalam mengkaji kemampuan klien untuk mengatasi stres.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan dukungan emosional dan bimbingan antisipasi untuk membantu klien mempelajari peran baru dan strategi untuk koping terhadap bayi baru lahir.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Keterampilan menjadi ibu / orang tua bukan secara insting tetapi harus dipelajari.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan pengungkapan rasa bersalah, kegagalan pribadi, atau keragu – raguan tentang kemampuan menjadi orang tua</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Membantu pasangan mengevaluasi kekuatan dan area masalah secara realistis dan mengenali kebutuhan terhadap bantuan profesional yang tepat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam merujuk klien/pasangan pada kelompok pendukungan menjadi orang tua, pelayanan sosial, kelompok komunitas, atau pelayanan perawat berkunjung.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Kira – kira 40 % wanita dengan depresi pascapartum ringan mempunyai gejala – gejala yang menetap sampai 1 tahun dan dapat memerlukan evaluasi lanjut.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i></b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pola tidur berhubungan dengan Respon hormonal dan<br />
psikologis (sangat gembira, ansietas, kegirangan), nyeri/ketidaknyamanan, proses persalinan dan kelahiran melelahkan.</span></i></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mengidentifikasi penilaian untuk mengakomodasi perubahan yang diperlukan dengan kebutuhan terhadap anggota keluarga baru, melaporkan peningkatan rasa sejahtera dan istirahat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi Keperawatan :</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji tingkat kelelahan dan kebutuhan untuk istirahat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Persalinan atau kelahiran yang lam dan sulit, khususnya bila ini terjadi malam, meningkatkan tingkat kelelahan. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji factor-faktor, bila ada yang mempengaruhi istirahat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Membantu meningkatkan istirahat, tidur dan relaksasi dan menurunkan rangsang.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan informasi tentang kebutuhan untuk tidur/istirahat setelah kembali ke rumah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Rencana yang kreatif yang membolehkan untuk tidur dengan bayi lebih awal serta tidur siang membantu untuk memenuhi kebutuhan tubuh.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan informasi tentang efek-efek kelelahan dan ansietas pada suplai ASI.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Kelelahan dapat mempengaruhi penilaian psikologis, suplai ASI, dan penurunan refleks secara psikologis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji lingkungan rumah, bantuan dirumah, dan adanya sibling dan anggota keluarga lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Multipara dengan anak di rumah memerlukan tidur lebih banyak dirumah sakit untuk mengatasi kekurangan tidur dan memenuhi kebutuhannya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i></b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurang pengetahuan mengenai perawatan diri dan perawatan bayi<br />
berhubungan dengan kurang pemajanan/mengingat, kesalahan interpretasi, tidak mengenal sumber – sumber.</span></i></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mengungkapkan berhubungan dengan pemahaman perubahan fisiologis, kebutuhan individu, hasil yang diharapkan, melakukan aktivitas / prosedur yang perlu dan menjelaskan alasan-alasan untuk tindakan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi Keperawatan :</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pastikan persepsi klien tentang persalinan dan kelahiran, lama persalinan, dan tingkat kelelahan klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Terhadap hubungan antara lama persalinan dan kemampuan untuk melakukan tanggung jawab tugas dan aktifitas-aktifitas perawatan diri/perawatan bayi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji kesiapan klien dan motivasi untuk belajar.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Periode pascanatal dapat merupakan pengalaman positif bila penyuluhan yang tepat untuk membantu pertumbuhan ibu, maturasi, dan kompetensi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan informasi tentang perawatan diri, termasuk perawatan perineal dan higiene, perubahan fisiologis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Membantu mencegah infeksi, mempercepat pemulihan dan penyembuhan, dan berperan pada adaptasi yang positif dari perubahan fisik dan emosional.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diskusikan kebutuhan seksualitas dan rencana untuk kontrasepsi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Pasangan mungkin memerlukan kejelasan mengenai ketersediaan metoda kontrasepsi dan kenyataan bahwa kehamilan dapat terjadi bahkan sebelum kunjungan sebelum kunjungan minggu ke-6.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Potensial terhadap pertumbuhan koping keluarga berhubungan dengan<br />
kecukupan pemenuhan kebutuhan-kebutuhan individu dan tugas-tugas adaptif, memungkinkan tujuan aktualisasi diri muncul ke permukaan.</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<b>Tujuan : </b>Mengungkapkan keinginan untuk melaksanakan tugas-tugas yang mengarah pada kerja sama dari anggota keluarga baru, mengekspresikan perasaan percaya diri dan kepuasan dengan terbentuknya kemajuan dan adaptasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 63pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi Keperawatan :</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji hubungan anggota keluarga satu sama lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Perawat dapat membantu memberikan pengalaman positif di rumah sakit dan menyiapkan keluarga terhadap pertumbuhan melalui tahap – tahap perkembangan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan partisipasi seimbang dari orang tua pada perawatan bayi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Fleksibilitas dan sensitifitasi terhadap kebutuhan keluarga membantu mengembangkan harga diri dan rasa kompeten dalam perawatan bayi baru lahir setelah pulang.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan bimbingan antisipasi mengenai perubahan emosi normal berkenaan dengan periode pascapartum.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Membantu menyiapkan pasangan untuk kemungkinan perubahan yang mereka alami, menurunkan stres dan meningkatkan koping positif.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan informasi tertulis mengenai buku-buku yang dianjurkan untuk anak-anak (sibling) tetang bayi baru.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Membantu anak mengidentifikasi dan mengatasi perasaan akan kemungkinan penggantian atau penolakan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam merujuk klien/pasangan pada kelompok orang tua pascapartum di komunitas.</span></div><div class="MsoListParagraphCxSpLast" style="color: #fce5cd; line-height: 150%; margin-left: 81pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Meningkatkan pengetahuan orang tua tentang membesarkan anak dan perkembangan anak. </span></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Implementasi</b></div><div class="MsoListParagraph" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Doenges (2000) implementasi adalah perawat mengimplementasikan intervensi-intervensi yang terdapat dalam rencana perawatan. Menurut Allen (1998) komponen dalam tahap implementasi meliputi tindakan keperawatann mandiri, kolaboratif, dokumentasi, dan respon pasien terhadap asuhan keperawatan. </span></div><div style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Evaluasi</b></div><div class="MsoListParagraph" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi didasarkan pada kemajuan pasien dalam mencapai hasil akhir yang ditetapkan yaitu meliputi ; kesejahteraan fisik ibu dan bayi akan dipertahankan. Ibu dan keluarga akan mengembangkan koping yang efektif. Setiap anggota keluarga akan melanjutkan pertumbuhan dan perkembangan yang sehat. Perawat dapat yakin bahwa perawatan berlangsung efektif jika kesejahteraan fisik ibu dan bayi dapat dipertahankan, ibu dan keluarganya dapat mengatasi masalahnya secara efektif, dan setiap anggota keluarga dapat meneruskan pola pertumbuhan dan perkembangan yang sehat.</span></div><div align="center" class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b></div><div align="center" class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENUTUP<br />
<br />
</span></b></div><div class="MsoListParagraph" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-indent: -27pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesimpulan</span></b></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Postpartum blues yaitu suatu perasaan bercampur aduk </span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebab postpartum blues belum diketahui secara pasti. </span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penderita postpartum dapat dideteksi melalui skrinning yaitu dengan kuisioner yang berupa pertanyaan tentang rasa cemas</span></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asuhan keperawatan pada pasien postpartum blues pada dasarnya harus holistik yaitu menyeluruh dari bio-psiko-sosio-spiritual dan melibatkan orang tua si anak yaitu ayah dan ibu si anak</span></div><div class="MsoListParagraph" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saran</span></b></div><div class="MsoNormal" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diharapkan makalah ini dapat menambah pengetahuan mahasiswa dalam memberikan pelayanan Keperawatan dan dapat menerapkannya dalam kehidupan sehari-hari. Dan untuk para tim medis agar dapat meningkatkan pelayanan kesehatan khususnya dalam bidang keperawatan sehingga dapat memaksimalkan kita untuk memberikan health education dalam perawatan depresi postpartum blues.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</div><div class="MsoListParagraphCxSpFirst" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bobak, Lowdermilk, Jensen. (2004). Buku Ajar: Keperawatan Maternitas edisi-4. Jakarta: EGC.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diposting oleh Agus Sutiono dalam Postpartum Blues. 2008. Tags: Konsep Dasar dan Askep Postpartum Blues. </span><a href="http://agussutionopathy.blogspot.com/2008/05/bab-i-tinjauan-pustaka-konsep-dasar.html"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://agussutionopathy.blogspot.com/2008/05/bab-i-tinjauan-pustaka-konsep-dasar.html</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. diakses tanggal 09 januari 2011</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diposting Oleh </span><a href="http://zietraelmart.multiply.com/"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; text-decoration: none;">zietraelmart</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dalam Postpartum Blues. 2008. Tags: Ilmu Jiwa Kebidanan.</span><a href="http://zietraelmart.multiply.com/journal/item/8/POST_PARTUM_BLUES"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://zietraelmart.multiply.com/journal/item/8/POST_PARTUM_BLUES</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. diakses tanggal 09 januari 2011</span></div><div class="MsoListParagraphCxSpLast" style="color: #fce5cd; line-height: 150%; margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Marilyn E. Doenges, 1999, <b><i>Rencana Asuhan Keperawatan</i></b>, Penerjemah Kariasa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">I Made, <span> </span>Jakarta : EGC.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="color: #fce5cd;"> </div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-3366645689918259222011-02-22T16:32:00.000-08:002011-02-22T16:32:38.453-08:00Askep Infeksi Neonatorum<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #f4cccc; line-height: 150%; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Latar belakang</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi neonatus adalah infeksi yang terjadi pada neonatus, dapat terjadi pada masa antenatal, perinatal, dan postpartum. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Blane (1961) infeksi pada neonatus dapat melalui beberapa cara :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi antenatal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kuman mencapai janin melalui peredaran darah ibu ke plasenta. Kuman melewati batas plasenta dan mengadakan intervilositas masuk ke vena umbilikus sampai ke janin. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi intranatal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Partus yang lama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan vagina yang terlalu sering.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi postpartum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penggunaan alat-alat dan perawatan yang tidak steril.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cross infection</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (infeksi yang telah ada di rumah sakit).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Rumusan masalah</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Berdasarkan uraian pada latar belakang diatas maka masalah yang dapat dirumuskan adalah sebagai berikut :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Apa pengertian dari infeksi neonatus ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bagaimana etiologi dari infeksi neonatus ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Apa k</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">lasifikasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> dari infeksi neonatus ?</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bagaimana p</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">atofisiologi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">dari infeksi neonatus ?</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Apa m</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">anifestasi klinis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> dari infeksi neonatus ?</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bagaimana p</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">enegakan diagnosis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> dari infeksi neonatus ?</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">Tujuan </span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Untuk mengetahui pengertian dari infeksi neonatus.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Untuk mengetahui etiologi dari infeksi neonatus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Untuk mengetahui k</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">lasifikasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> dari infeksi neonatus.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Untuk mengetahui p</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">atofisiologi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">dari infeksi neonatus.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Untuk mengetahui m</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">anifestasi klinis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> dari infeksi neonatus.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: #f4cccc; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Untuk mengetahui p</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">enegakan diagnosis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> dari infeksi neonatus.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="color: #f4cccc; line-height: 150%;"><br />
</div><div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">KONSEP DASAR</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Definisi</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi neonatus adalah infeksi yang terjadi pada neonatus, dapat terjadi pada masa antenatal, perinatal, dan postpartum. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Etiologi</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Blane (1961) infeksi pada neonatus dapat melalui beberapa cara :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi antenatal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kuman mencapai janin melalui peredaran darah ibu ke plasenta. Kuman melewati batas plasenta dan mengadakan intervilositas masuk ke vena umbilikus sampai ke janin. Kuman tersebut seperti :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Virus : rubella, poliomelitis, koksakie, variola, dan lain-lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Spirokaeta : sifilis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bakteri : jarang sekali kecuali E. Coli dan listeria. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi intranatal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Partus yang lama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan vagina yang terlalu sering.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi postpartum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penggunaan alat-alat dan perawatan yang tidak steril.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cross infection</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (infeksi yang telah ada di rumah sakit).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Klasifikasi</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi berat (<i>major infection</i>)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sifilis kongenital</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biasanya terjadi pada masa antenatal, yang disebabkan oleh <i>Treponema pallidum.</i></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sepsis neonatorum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat terjadi pada antenatal dan postnatal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningitis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biasanya didahului sepsis, penyebab utamanya adalah E.colli, pneumokokus, stafilokokus, dan sebagainya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pneumonia kongenital</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadi pada masa intranatal karena adanya aspirasi likuor amnion yang septik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pneumonia aspirasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadi pada masa postnatal, merupakan penyebab kematian<span> </span>utama pada bayi BBLR (berat badan lahir rendah), terjadi aspirasi pada saat pemberian makanan karena refleks menelan dan batuk yang belum sempurna.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pneumonia karena <i>airborn infection</i></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi terjadi karena berhubungan dengan orang dewasa yang menderita infeksi saluran pernapasan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pneumonia stafilokokus</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biasanya terjai pada neonatus yang lahir di rumah sakit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diare epidemik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi yang menyebabkan kematian yang tinggi,disebabkan oleh E.colli yang bersifat patogen.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gastroenteritis E.colli</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Salmonelosis </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pielonefritis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi yang mengenai ginjal bayi. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>j.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ostitis akut</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Disebabakan oleh metastasis sarang infeksi stafilokokus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>k.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tetanus<i> </i>neonatorum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Disebabkan oleh clostridium yang bersifat anaerob dan mengeluarkan<span> </span>eksotopin yang neurotropik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi ringan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemfigus neonatorum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gelombang jernih yang berisih nanah yang kemudian kemerahan pada kulit disebabkan oleh stafilokokus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Oftalmia neonatorum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi genokokus pada konjungtiva waktu melewati jalan lahir.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi pusat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Disebabkan oleh stafilokokus aureus, sehingga menimbulkan nanah, edema, dan kemerahan pada ujung pusat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Moniliasis </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kandida albikans merupakan jamur yang sering ditemukan pada bayi yang dapat menyebabkan stomatitis, diare, dermatitis, dan lain-lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Patofisiologi </span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patofisiologi dimulai dengan masuknya bakteri dan mengontaminasi sirkulasi sistemik. Bakteri melepaskan endotoksin dan menyebabkan terganggunya proses metabolisme secara progresif. Pada keadaan fulminan (tiba-tiba berat)dapat<span> </span>menyebabkan kerusakan dan kematian sel karena aktivasi sepsis dengan komlpemen. Hasilnya menyebabkan penurunan perfusi jaringan, asidosis metabolik, serta syok yang menyebabkan <i>disseminated intravaskular coagulatian</i> (DIC) dan kematian.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Manifestasi klinis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi klinis dari infeksi neonatus di mulai tanpa gejala, tanda-tanda ringan, menggigit, iritabel, letargi, gelisah, dan keinginan menyusu yang kurang dapat menjadi tanda-tanda utama. Temperatur yang tidak stabil dapat meninggi atau kurang dari normal (biasanya hipotermia terjadi pada bayi BBLR). Perubahan warna kulit, lambatnya waktu pengisian kapiler, perubahan denyut jantung,<span> </span>frekuensi nafas, berat badab tiba-tiba turun, pergerakan kurang, muntah dan diare menjadi nyata pada keadaan penyakit yang progresif. Selain itu, dapat terjadi edema, salerema purpura atau perdarahan, ikterus, hepatosplenomegali, dan kejang. Umumnya dapat dikatakan bila bayi itu “not doing well” kemungkinan besar ia menderita infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Manifestasi lainnya adalah data laboratorium yang tidak stabil (khususnya hipoglikemia) dan neptropenia. Diagnosis dapat dikonfirmasikasikan dengan kultur darah yang positif. Kultur ini dapat memekan waktu 48 jam. Sedangkan perjalanan sepsis dapat mengakibatkan kematian dalam beberapa jam. Oleh karena itu, kita harus memulai terapi antibiotik secepatnya. Antibiotik dapat tidak dilanjutkan kultur darah negatif dan bayi tidak menunjukkan gejala sepsis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Neonatus terutama BBLR yang dapat tetap hidup selama 72 jam pertama dan bayi tersebut menunjukkan gejala penyakit atau menderita penyakit kongenital tertentu. Namun tingkah lakunya berubah dapat dicurigai terjadi infeksi (Hutchinson, 1972). <span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Penegakan diagnosis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis infeksi perinatal sangat penting, yaitu di samping untuk kepentingan bayi itu sendiri juga lebih penting lagi untuk kamar bersalin dan ruang perawatannya. Diagnosis infeksi perinatal tidaklah mudah. Tanda khas seperti yang terdapat pada bayi sering kali tidak ditemukan. Biasanya diagnosis yang ditegakkan dengan observasi yang teliti, amnesia kehamilan dan persalinan<span> </span>yang teliti, serta akhirnya dengan pemeriksaan fisik dan laboratorium. Infeksi pada neonatus cepat sekali menjalar menjadi infeksi umum, sehingga gejala infeksi lokal tidak menonjol lagi. Walaupun demikian, diagnosis dini dapat kita tegakkan jika kita cukup waspada terhadap tingkah laku neonatus yang sebagai pertanda awal dari permulaan infeksi umum.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menegakkan diagnosis sepsis<span> </span>perlu dilakukan pemeriksaan penunjang sebagai berikut :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hitung darah lengkap dengan turunannya</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang terpenting adalah jumlah sel darah merah (WBC).septik neonatus biasanya menunjukkan penurunan jumlah white blood cell (WBC), yaitu kurang dari 500 mm. Hitung jenis darah juga menunjukkan banyak WBC tidak matang dalam aliran darah. Banyaknya darah tidak matang dihubungkan dengan jumlah total WBC diidentifikasikan bahwa bayi men galami respons yang signifikan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Platelet</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biasanya 150.000 sampai 300.000 mm pada keadaan sepsis platelet munurun, kultur darah gram negatif atau positif, dan tes sensitivitas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil dari kultur harus tersedia<span> </span>dalam beberapa jam dan akan mengindikasikan jumlah dan jenis bakteri. Kultur darah atau sensitivitas membutuhkan waktu 24 – 48 jam untuk mengembangkan dan mengidentifikasikan<span> </span>jenis patogen serta antibiotik yang sesuai.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lumbal pungsi untuk kultur dan tes sensitivitas pada cairan serebrospinal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hal ini dilakukan jika ada<span> </span>indikasi infeksi neuron.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kultur urine</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kultur permukaan (<i>surface culture</i>)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengidentifikasi kolonisasi, tidak spesifik untuk infeksi bakteri.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pencegahan infeksi pada neonatus</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cara pencegahan pada neonatus dapat dibagi sebagai berikut :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cara umum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 126pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pencegahan infeksi neonatus sudah harus dimulai dari periode antenatal infeksi ibu harus diobati dengan baik, misalnya infeksi umum, lekorea, dan lain –lain. Di kamar bersalin harus ada pemisahan<span> </span>yang sempurna antara bagian yang sepsis dengan aseptik. Pemisahan ini mencakup ruangan, tenaga perawatan, serta alat kedokteran dan alat perawatan. Ibu yang akan melahirkan sebelumnya masuk kamar bersalin. Pada kelahiran bayi, pertolongan harus dilakukan secara aseptik. Suasana kamar bersalin harus sama dengan kamar operasi. Alat yang digunakan harus steril.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 126pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di kamar bayi yang baru lahir harus ada pemisahan yang sempurna untuk bayi yang baru lahir dengan partus aseptik dan partus septik. Pemisahan ini harus mencakup personalia, fasilitas perawatan, dan alat yang digunakan. Selain itu juga dilakukan pemisahan terhadap bayi yang menderita penyakit menular. Perawat harus mendapat pendidikan khusus dan mutu perawatan harus baik, apalagi bila kamar perawatan bayi merupakan suatu kamar perawatan yang khusus. Sebelum dan sesudah memegang bayi harus cuci tangan. Mencuci tangan dengan menggunakan sabun antiseptik atau sabun biasa asal cukup lama, dalam ruangan harus memakai jubah steril, masker, dan sandal khusus. Dalam ruangan bayi, kita tidak boleh banyak bicara,<span> </span>dan bila menderita sakit saluran pernapasan atas, tidak boleh masuk kamar bayi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 126pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapur susu harus bersih dan cara mencampur harus aspetik air susu ibu yang dipompa sebelum diberikan<span> </span>kepada bayi harus dipasteurisasi dulu. Setiap bayi harus punya tempat pakaian tersendiri, begitu juga inkubator harus sering dibersihkan dan lantai ruangan setiap hari harus dibersihkan serta setiap minggu dicuci dengan menggunakan antiseptik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cara khusus</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 126pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemakaian antibiotik hanya untuk tujuan dan indikasi yang jelas.</span></div><div class="MsoListParagraphCxSpLast" style="color: #f4cccc; line-height: 150%; margin-left: 126pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada beberapa keadaan, misalnya ketuban pecah lama (lebih dari 12 jam) air ketuban keruh, infeksi sistemik pada ibu, partus yang lama dan banyak manipulasi intravaginal. Resusitasi<span> </span>yang berat sering timbul dilema<span> </span>apakah akan digunakan antibiotik secara prokfilaksis. Penggunaan antibiotik yang banyak dan tidak terarah dapat menyebabkan timbulnya jamur yang berlebihan, misalnya kandida albikans. Sebaliknya jika terlambat memberikan antibiotik pada penyakit infeksi neonatus, seringmberakibat kematian.</span></div><div class="MsoNormal" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berdasarkan hal diatas, dapat disimpulkan sebagai berikut :</span></div><div class="MsoListParagraphCxSpFirst" style="color: #f4cccc; line-height: 150%; margin-left: 126pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila kemampuan pengawasan klinis dan laboratoriun cukup baik, sebaiknya tidak perlu memberikan antibiotika profilaksis, antibiotika baru diberikan<span> </span>kalau sudah terdapat tanda infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 126pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila kemampuan tersebut tidak ada maka dapat digunakan pemberian antibiotik profilaksis berupa ampisilin 100 mg/kgbb/hari dan gentamisin3-5 mg/kgbb/hari salama 3-5 hari. Selain hal yang telah diterapkan di atas, petugas yang merupakan karier hukum tertentu harus hati-hati dalam menjalankan tugas perawatan. Masih merupakan masalah yang belum terpecahkan apakah para karier ini harus dilarang bekerja di bangsal perawatan bayi baru lahir dan harus diobati lebih dahulu. Namun, selama syarat aseptik dan antiseptik diperhatikan kemungkinan petugas ini untuk menularkan penyakit dapat diatasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 126pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada dua alasan utama yang menyebabkan infeksi neonatus, yaitu perlindungan dari uterus tidak ada lagi, dan tidak cukupnya daya tahan tubuh neonatus terhadap penyakit. Fetus dapat terinfeksi dari uterus atau neonatus terinfeksi sepanjang jalan lahir atau dari infeksi asendens yang mengikuti ruptur membran. Infeksi perinatal menyebabkan transmisi vertikal infeksi. Contoh transmisi vertikal ini adalah infeksi Toxoplasmosis Other Rubella Cytomegalo (TORCH), virus dan herpes kongenital, serta hepatitis.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="color: #f4cccc;"><br />
</div><div style="color: #f4cccc;"> </div><div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">ASUHAN KEPERAWATAN</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;"></span></b></div><div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">( Infeksi neonatus )</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pengkajian</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perawat mempunyai tugas yang penting dalam mengkaji tanda-tanda infeksi pada neonatus, tanda dan gejala sepsis pada neonatus sering tak terlihat dan dikenali oleh pemberi keperawatan profesional. Perawat neonatus mempunyai tanggung jawab untuk mengenali tanda-tanda, sehingga diagnosis dan perawatannya dapat diberikan segera.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biodata bayi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan sekarang</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem saraf pusat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fontanel yang menonjol.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Letargi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Temperatur yang tidak stabil.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipotonia.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tremor yang kuat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem pencernaan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hilangnya keinginan untuk menyusui.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penurunan intake melalui oral.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diare.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Distensi abdomen.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem integumen</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kuning. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya lesi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ruam. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem pernapasan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apnea.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sianosis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Takipnea.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penurunan saturasi oksigen.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nasal memerah, mendengkur, dan retraksi dinding dada.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem kardiovaskular</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Takikardi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurunnya denyut perifer.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pucat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan keluarga</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apakah ada anggota keluarga yang menderita sifilis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data psikologi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluhan dan reaksi bayi terhadap penyakitnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingkat adaptasi bayi terhadap penyakitnya. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Diagnosis keperawatan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis keperawatan yang mungkin ditemukan pada infeksi neonatus :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak efektifnya pola napas yang berhubungan dengan meningkatnya sekret di saluran napas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan suhu tubuh yang berhubungan dengan proses infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pemenuhan nutrisi kurang dari kebutuhan tubuh yang berhubungan dengan malas minum, diare, dan muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurangnya volume cairan yang berhubungan dengan diare dan malas menyusui.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman dan aman yang berhubungan dengan infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Intervensi keperawatan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis 1: tidak efektifnya pola napas yang berhubungan dengan meningkatnya sekret di saluran napas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data objektif: bayi t ampak sesak napas, gelisah, frekuensi pernapasan meningkat, dan sekret berlebihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan: setelah dilakukan tindakan keperawatan ketidakefektifan pernapasan dapat diatasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil: bayi tidak sesak lagi, bayi tenang, frekuensi pernapasan menurun, sekret di saluran napas tidak ada lagi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi: </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tempatkan bayi pada posisi yang nyaman, kepala ditinggikan (misalnya digendong).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: posisi yang baik dapat membantu melonggarkan jalan napas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan O2 dan bersihkan jalan napas dari sekret.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: O2 mengatasi kebutuhan tubuh akan oksigen dan membersihkan jalan napas akan mengurangi sumbatan di saluran napas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan dokter tentang pemberian antibiotik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: antibiotik dapat mengatasi infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis 2: gangguan pemenuhan nutrisi yang berhubungan dengan malas minum, diare, dan muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data objektif: bayi malas minum atau menyusui, muntah, diare, berat badan menurun, dan gelisah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan: setelah dilakukan tindakan keperawatan, gangguan pemenuhan nutrisi dapat diatasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil: muntah dan diare berhenti, bayi mau disusui.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan pada ibu untuk tetap memberikan ASI.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: ASI mengandung IgA dalam jumlah tinggi yang dapat memberikan imunitas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Auskultasi bising usus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: penurunan aliran darah dapat menurunkan peristaltik usus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan dokter tentang pemberian obat-obatan seperti antibiotik dan pemberian cairan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: antibiotik dapat mengatasi infeksi yang akan memperberat infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis 3: kurangnya volume cairan tubuh yang berhubungan dengan diare, muntah, dan malas minum.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data objektif:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Turgor buruk dan kulit kering.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membran mukosa kering.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertermi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Masa menyusui.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diare.</span></div><div class="MsoListParagraphCxSpLast" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Muntah.</span></div><div class="MsoNormal" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan: setelah dilakukan tindakan keperawatan, volume cairan kembali normal.</span></div><div class="MsoNormal" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil: suhu normal,membran mukosa dan kulit tidak lagi kering.</span></div><div class="MsoNormal" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:</span></div><div class="MsoListParagraphCxSpFirst" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan pada ibu tetap memberikan ASI.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: ASI mengandung IgA dalam jumlah tinggi dapat memberikan imunitas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Awasi masukan dan pengeluaran, catat dan ukur frekuensi diare, dan kehilangan cairan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: perubahan pada kualitas susu sangat mempengaruhi kebutuhan cairan dan peningkatan risiko dehidrasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan dokter tentang pemberian obat-obatan dan terapi cairan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: terapi cairan dapat membantu mengurangi gangguan cairan tubuh.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis 4 : perubahan suhu tubuh yang berhubungan dengan proses infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : Setelah dilakukan tindakan keperawatan, suhu tubuh bayi kembali normal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil : tidak ada tanda-tanda hipertermi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau suhu pasien (derajat dan<span> </span>pola ) ; perhatikan bunyi menggigil / diaforesis.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : suhu 38,9 derajat sampai 41 derajat menunjukan proses penyakit infeksius akut. Pola demam dapat membantu dalam diagnosis.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau suhu lungkunagn, batasi atau tambahkan linen tempat tidur, sesuai indikasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : suhu ruangan atau jumlah selimut harus di ubah untuk mempertahankan suhu mendekati normal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan kompres mandi hangat ; hindari penggunaan alkohol</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : dapat membantu mengurangi demam</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan antipiretik, misalnya ASA (aspirin), asetaminofen (tylenol).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 90pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : digunakan untuk mengurangi demam dengan aksi sentralnya pada hipotalamus, meskipun demam mungkin dapat berguna dalam membatasi pertumbuhan organisme, dan meningkatkan autodestruksi dari sel-sel yang terinfeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">antibiotik</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 90pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">antimikroba mengobati infeksi yang menjadi penyebab penyakit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis 5 : </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman dan aman yang berhubungan dengan infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : setelah dilakukan tindakan keperawatan, bayi tidak rewel</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil : tidak ada tanda-tanda nyeri,bayi nampak tenang.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menjelaskan proses terjadinya infeksi kepada keluarga klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : agar tidak adda kekhawatiran saat terjadi sesuatu</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri lingkungan tenang dan nyaman</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : menurunkan reaksi terhadap terhadap stimulus dari luar agar dapat meningkatkan istrahat atau relaksasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Implementasi keperawatan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Implementasi merupakan tindakan yang sesuai dengan yang telah direncanakan, mencakup tindakan mandiri dan kolaborasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tindakan mandiri adalah tindakan keperawatan berdasarkan analisis dan kesimpulan perawat dan bukan atas putunjuk tenaga kesehatan lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tindakan kolaborasi adalah tindakan keperawatan yang didasarkan oleh hasil keputusan bersama dengan dokter atau petugas kesehatan lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Evaluasi keperawatan</span></b></div><div class="MsoListParagraphCxSpLast" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merupakan hasil perkembangan ibu dengan berpedoman kepada hasil dan tujuan yang hendak dicapai.</span></div><div class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB IV</span></b></div><div align="center" class="MsoNormal" style="color: #f4cccc; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENUTUP</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: #f4cccc; line-height: 150%; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Kesimpulan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi neonatus adalah infeksi yang terjadi pada neonatus, dapat terjadi pada masa antenatal, perinatal, dan postpartum. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Blane (1961) infeksi pada neonatus dapat melalui beberapa cara :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi antenatal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kuman mencapai janin melalui peredaran darah ibu ke plasenta. Kuman melewati batas plasenta dan mengadakan intervilositas masuk ke vena umbilikus sampai ke janin. Kuman tersebut seperti :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Virus : rubella, poliomelitis, koksakie, variola, dan lain-lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Spirokaeta : sifilis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bakteri : jarang sekali kecuali E. Coli dan listeria. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi intranatal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Partus yang lama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan vagina yang terlalu sering.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi postpartum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penggunaan alat-alat dan perawatan yang tidak steril.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cross infection</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (infeksi yang telah ada di rumah sakit).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Saran </span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagi para pembaca, diharapkan dapat memetik pemahaman dari uraian yang dipaparkan diatas, dan dapat mengaplikasikannya dalam lingkungan masyarkat sehingga dapat mencegah </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">infeksi neonatus</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagi mahasiswa, diharapkan agar terus menambah wawasan khususnya dalam bidang keperawatan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: #f4cccc; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; 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</style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1074"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> <o:rules v:ext="edit"> <o:r id="V:Rule1" type="connector" idref="#_x0000_s1060"/> <o:r id="V:Rule2" type="connector" idref="#_x0000_s1049"/> <o:r id="V:Rule3" type="connector" idref="#_x0000_s1058"/> <o:r id="V:Rule4" type="connector" idref="#_x0000_s1046"/> <o:r id="V:Rule5" type="connector" idref="#_x0000_s1069"/> <o:r id="V:Rule6" type="connector" idref="#_x0000_s1070"/> <o:r id="V:Rule7" type="connector" idref="#_x0000_s1061"/> <o:r id="V:Rule8" type="connector" idref="#_x0000_s1045"/> <o:r id="V:Rule9" type="connector" idref="#_x0000_s1054"/> <o:r id="V:Rule10" type="connector" idref="#_x0000_s1064"/> <o:r id="V:Rule11" type="connector" idref="#_x0000_s1052"/> <o:r id="V:Rule12" type="connector" idref="#_x0000_s1057"/> <o:r id="V:Rule13" type="connector" idref="#_x0000_s1073"/> <o:r id="V:Rule14" type="connector" idref="#_x0000_s1053"/> <o:r id="V:Rule15" type="connector" idref="#_x0000_s1071"/> <o:r id="V:Rule16" type="connector" idref="#_x0000_s1059"/> <o:r id="V:Rule17" type="connector" idref="#_x0000_s1051"/> <o:r id="V:Rule18" type="connector" idref="#_x0000_s1056"/> <o:r id="V:Rule19" type="connector" idref="#_x0000_s1055"/> <o:r id="V:Rule20" type="connector" idref="#_x0000_s1066"/> <o:r id="V:Rule21" type="connector" idref="#_x0000_s1072"/> <o:r id="V:Rule22" type="connector" idref="#_x0000_s1063"/> <o:r id="V:Rule23" type="connector" idref="#_x0000_s1062"/> <o:r id="V:Rule24" type="connector" idref="#_x0000_s1065"/> <o:r id="V:Rule25" type="connector" idref="#_x0000_s1050"/> </o:rules> </o:shapelayout></xml><![endif]--> <div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Latar belakang</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif";">Penyakit saluran pernapasan merupakan salah satu penyebab kesakitan dan kematian yang paling sering dan penting pada anak, terutama pada bayi, karena saluran pernafasannya masih sempit dan daya tahan tubuhnya masih rendah. Disamping faktor organ pernafasan , keadaan pernafasan bayi dan anak juga dipengaruhi oleh beberapa hal lain, seperti suhu tubuh yang tinggi, terdapatnya sakit perut, atau lambung yang penuh. Penilaian keadaan pernafasan dapat dilaksanakan dengan mengamati gerakan dada dan atau perut.Neonatus normal biasanya mempunyai pola pernafasan abdominal. Bila anak sudah dapat berjalan pernafasannya menjadi thorakoabdominal. Pola pernafasan normal adalah teratur dengan waktu ekspirasi lebih panjang daripada waktu inspirasi, karena pada inspirasi otot pernafasan bekerja aktif, sedangkan pada waktu ekspirasi otot pernapasan bekerja secara pasif. Pada keadaan sakit dapat terjadi beberapa kelainan pola pernapasan yang paling sering adalah takipneu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif";">Ganguan pernafasan pada bayi dan anak dapat disebabkan oleh berbagai kelainan organic, trauma, alergi, insfeksi dan lain-lain. Gangguan dapat terjadi sejak bayi baru lahir. Gangguan pernapasan yang sering ditemukan pada bayi baru lahir (BBL) termasuk respiratory distress syndrome (RDS) atau idiopatic respiratory distress syndrome (IRDS) yang terdapat pada bayi premature.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif";">Sindrom gawat nafas pada neonatus (SGNN) dalam bahasa inggris disebut respiratory disstess syndrome, merupakan kumpulan gejala yang terdiri dari dispneu atau hiperpneu. Sindrom ini dapat terjadi karena ada kelainan di dalam atau diluar paru. Oleh karena itu, tindakannya disesuaikan dengan penyebab sindrom ini. Beberapa kelainan dalam paru yang menunjukan sindrom ini adalah pneumothoraks/pneumomediastinum, penyakit membram hialin (PMH), pneumonia, aspirasi, dan sindrom Wilson- Mikity (Ngastiyah, 1999).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif";">RDS terjadi pada bayi prematur atau kurang bulan, karena produksi surfaktan, yang dimulai sejak kehamilan minggu ke 22, makin muda usia kehamilan, makin besar pula kemungkinan terjadi RDS dan kelainan ini merupakan penyebab utama kematian bayi prematur.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Banyak teori yang menerangkan patogenesis dari syndrom yang berhubungan dengan kerusakan awal paru-paru yang terjadi dimembran kapiler alveolar.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Rumusan Masalah</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berdasarkan uraian pada latar belakang diatas maka masalah yang dapat dirumuskan adalah sebagai berikut :</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa pengertian dari Respiratori Distres Sindrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana Etiologi dari Respiratori Distres Sindrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana patofisiologi dari Respiratori Distres Sindrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana manifestasi klinis dari Respiratori Distres Sindrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa<span> </span>Insiden dari Respiratory Distress Syndrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa komplikasi dari Respiratory Distress Syndrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana pemeriksaan diagnostik dari Respiratory Distress Syndrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana terapi / penatalaksanaan dari Respiratory Distress Syndrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana asuhan keperawatan pada klien anak dengan Respiratory Distress Syndrome ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Tujuan </span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Umum</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui konsep penyakit yang berhubungan dengan Respiratory Distress Syndrome serta Asuhan Keperawatan Respiratory Distress Syndrome</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Khusus</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui pengertian dari Respiratory Distress Syndrome </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui Etiologi dari Respiratory Distress Syndrome </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui patofisiologi Respiratory Distress Syndrome </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui manifestasi klinis Respiratory Distress Syndrome </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui Insiden dari Respiratory Distress Syndrome </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui komplikasi dari Respiratory Distress Syndrome </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui pemeriksaan diagnostik Respiratory Distress Syndrome </span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui terapi / penatalaksanaan dari Respiratory Distress Syndrome </span></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;"> </span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PEMBAHASAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pengertian</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Respiratory Distress Syndrome (RDS) disebut juga Hyaline Membrane Disease (HMD), merupakan sindrom gawat napas yang disebabkan defisiensi surfaktan terutama pada bayi yang lahir dengan masa gestasi kurang. (Malloy & Freeman 2000).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RDS adalah gangguan pernafasan yang sering terjadi pada bayi premature dengan tanda-tanda takipnue (>60 x/mnt), retraksi dada, sianosis pada udara kamar, yang menetap atau memburuk pada 48-96 jam kehidupan dengan x-ray thorak yang spesifik (Stark,1986).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RDS adalah perkembangan yang imatur pada sistem pernafasan atau tidak adekuatnya jumlah surfaktan dalam paru. RDS dikatakan sebagai Hyaline Membrane Disesae (Suryadi, 2001).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RDS adalah suatu sindrom kegawatan pada pernafasan yang terdiri atas gejala dispneu, pernafasan cepat lebih dari 60 kali permenit, sianosis, merintih pada saat ekspirasi; terdapat retraksi pada suprasternal, interkostal dan epigastrium. Pada penyakit ini terjadi perubahan paru yaitu berupa pembentukan jaringan hialin pada membran paru yang rusak. Kerusakan pada paru timbul akibat kekurangan komponen surfaktan pulmonal. Surfaktan adalah suatu zat aktif yang memberikan pelumasan pada ruang antar alveoli sehingga dapat mencegah pergesekan dan timbulnya kerusakan pada alveoli yang selanjutnya akan mencegah terjadinya kolaps paru. (Yuliani, 2001)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Epidemiologi</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diperkirakan ada 150.000 orang yang menderita RDS tiap tahunnya dan tingkat mortilitasnya 50 %.Sepsis sistemik merupakan penyebab RDS terbesar sekitar 50%, trauma 15 %, cardiopulmonary baypass 15 %, viral pneumoni 10 % dan injeksi obat 5 %.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Etiologi / factor predisposisi</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebab kelainan ini secara garis besar adalah kekurangan surfaktan, suatu zat aktif pada alveoli yang mencegah kolaps paru.RDS seringkali terjadi pada bayi prematur, karena produksi surfaktan, yang dimulai sejak kehamilan minggu ke-22, baru mencapai jumlah cukup menjelang cukup bulan. Makin muda usia kehamilan, makin besar pula kemungkinan terjadinya RDS. Kelainan merupakan penyebab utama kematian bayi prematur. Adapun penyebab-penyebab lain yaitu:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan bawaan/kongenital jantung atau paru-paru.</span></i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila bayi mengalami sesak napas begitu lahir atau 1-2 hari kemudian, biasanya disebabkan adanya kelainan jantung atau paru-paru. Hal ini bisa terjadi pada bayi dengan riwayat kelahiran normal atau bermasalah, semisal karena ketuban pecah dini atau lahir prematur. Pada bayi prematur, sesak napas bisa terjadi karena adanya kekurangmatangan dari organ paru-paru. Paru-paru harusnya berfungsi saat bayi pertama kali menangis, sebab saat ia menangis, saat itu pulalah bayi mulai bernapas. Tapi pada bayi lahir prematur, karena saat itu organnya tidak siap, misalnya gelembung paru-paru tak bisa mekar atau membuka, sehingga udara tidak masuk. Itu sebabnya ia tak bisa menangis. Ini yang namanya penyakit respiratory distress syndrome (RDS). Tidak membukanya gelembung paru-paru tersebut karena ada suatu zat, surfactan, yang tak cukup sehingga gelembung paru-paru atau unit paru-paru yang terkecil yang seperti balon tidak membuka. Ibaratnya, seperti balon kempis. Gejala pada kelainan jantung bawaan adalah napas sesak. Ada juga yang misalnya sedang menyusui atau beraktivitas lainnya, mukanya jadi biru dan ia jadi pasif. Jadi, penyakitnya itu utamanya karena kelainan jantung dan secondary-nya karena masalah pernapasan. Jadi, biasanya sesak napas yang terjadi ini tidak bersifat mendadak. Walaupun demikian, tetap harus segera dibawa ke dokter.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan pada jalan napas/trakea.</span></i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan bawaan/kongenital ini pun paling banyak ditemui pada bayi. Gejalanya, napas sesak dan napas berbunyi "grok-grok". Kelainan ini terjadi karena adanya hubungan antara jalan napas dengan jalan makanan/esophagus. Kelainan ini dinamakan dengan trackeo esophageal fistula. Akibat kelainan itu,ada cairan lambung yang bisa masuk ke paru-paru. Tentunya ini berbahaya sekali. Sehingga pada usia berapa pun diketahuinya, harus segera dilakukan tindakan operasi. Tak mungkin bisa menunggu lama karena banyak cairan lambung bisa masuk ke paru-paru. Sebelum operasi pun dilakukan tindakan yang bisa menolong jiwanya, misal dengan dimasukkan selang ke jalan napas sehingga cairan dari lambung tak bisa masuk. Biasanya sesak napasnya tampak begitu waktu berjalan 1-3 jam setelah bayi lahir. Nah, bila ada sesak napas seperti ini, prosedur yang harus dilakukan adalah dilakukan foto rontgen segera untuk menganalisanya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tersedak air ketuban.</span></i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada juga penyakit-penyakit kelainan perinatologi yang didapat saat kelahiran. Karena suatu hal, misalnya stres pada janin, ketuban jadi keruh dan air ketuban ini masuk ke paru-paru bayi. Hal ini akan mengakibatkan kala lahir ia langsung tersedak. Bayi tersedak air ketuban akan ketahuan dari foto rontgen, yaitu ada bayangan "kotor". Biasanya ini diketahui pada bayi baru lahir yang ada riwayat tersedak, batuk, kemudian sesak napasnya makin lama makin berat. Itulah mengapa, pada bayi baru lahir kita harus intensif sekali menyedot lendir dari mulut, hidung atau tenggorokannya. Bahkan jika tersedak air ketubannya banyak atau massive, harus disedot dari paru-paru atau paru-parunya dicuci dengan alat bronchowash. Lain halnya kalau air ketubannya jernih dan tak banyak, tak jadi masalah. Namun kalau air ketubannya hijau dan berbau, harus disedot dan "dicuci" paru-parunya. Sebab, karena tersedak ini, ada sebagian paru-parunya yang tak bisa diisi udara/atelektasis atau tersumbat, sehingga menyebabkan udara tak bisa masuk. Akibatnya, jadi sesak napas. Biasanya kalau di-rontgen,bayangannya akan terlihat putih. Selain itu, karena tersumbat dan begitu hebat sesak napasnya,ada bagian paru-paru yang pecah/kempes/pneumotoraks. Ini tentu amat berbahaya. Apalagi kejadiannya bisa mendadak dan menimbulkan kematian. Karena itu bila sesak napas seperti ini, harus lekas dibawa ke dokter untuk mendapatkan alat bantu napas/ventilator.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembesaran kelenjar thymus.</span></i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada lagi napas sesak karena beberapa penyakit yang cukup merisaukan yang termasuk kelainan bawaan juga. Gejalanya tidak begitu kuat. Biasanya bayi-bayi ini pun lahir normal, tak ada kelainan, menangisnya pun kuat. Hanya saja napasnya seperti orang menggorok dan semakin lama makin keras, sampai suatu saat batuk dan berlendir. Kejadian ini lebih sering dianggap karena susu tertinggal di tenggorokan. Namun ibu yang sensitif biasanya akan membawa kembali bayinya ke dokter. Biasanya kemudian diperiksa dan diberi obat. Bila dalam waktu seminggu tak sembuh juga, baru dilakukan rontgen. Penyebabnya biasanya karena ada kelainan pada jalan napas, yaitu penyempitan trakea. Ini dikarenakan adanya pembesaran kelenjar thymus. Sebetulnya setiap orang punya kelenjar thymus. Kelenjar ini semasa dalam kandungan berfungsi untuk sistem kekebalan. Letaknya di rongga mediastinum (diantara dua paru-paru). Setelah lahir karena tidak berfungsi, maka kelenjar thymus akan menghilang dengan sendirinya. Namun adakalanya masih tersisa: ada yang kecil, ada juga yang besar; baik hanya satu atau bahkan keduanya. Nah, kelenjar thymus yang membesar ini akan menekan trakea. Akibatnya, trakea menyempit dan mengeluarkan lendir. Itu sebabnya napasnya berbunyi grok-grok dan keluar lendir, sehingga jadi batuk. Pengobatannya biasanya dilakukan dengan obat-obatan khusus untuk mengecilkan kelenjar thymus agar tidak menekan trakea. Pemberian obat dalam waktu 2 minggu. Kalau tak menghilang, diberikan lagi pengobatan selama seminggu. Sebab, jika tidak diobati, akan menganggu pertumbuhan si bayi. Berat badan tak naik-naik, pertumbuhannya kurang, dan harus banyak minum obat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan pembuluh darah.</span></i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada lagi kelainan yang gejalanya seperti mendengkur atau napasnya bunyi (stridor), yang dinamakan dengan vascular ring. Yaitu,adanya pembuluh darah jantung yang berbentuk seperti cincin (double aortic arch) yang menekan jalan napas dan jalan makan. Jadi, begitu bayi lahir napasnya berbunyi stridor. Terlebih kalau ia menangis, bunyinya semakin keras dan jelas. Bahkan seringkali dibarengi dengan kelainan menelan, karena jalan makanan juga terganggu. Pemberian makanan yang agak keras pun akan menyebabkannya muntah, sehingga anak lebih sering menghindari makanan padat dan maunya susu saja. Pengobatannya, bila setelah dirontgen tidak ditemui kelenjar thymus yang membesar, akan diminta meminum barium untuk melihat apakah ada bagian jalan makan yang menyempit. Setelah diketahui, dilakukan tindakan operasi, yaitu memutuskan salah satu aortanya yang kecil.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tersedak makanan.</span></i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tersedak atau aspirasi ini pun bisa menyebabkan sesak napas. Bisa karena tersedak susu atau makanan lain, semisal kacang. Umumnya karena gigi mereka belum lengkap, sehingga kacang yang dikunyahnya tidak sampai halus. Kadang juga disebabkan mereka menangis kala mulutnya sedang penuh makanan. Atau ibu yang tidak berhati-hati kala menyusui, sehingga tiba-tiba bayinya muntah. Mungkin saja sisa muntahnya ada yang masih tertinggal di hidung atau tenggorokan. Bukankah setelah muntah, anak akan menangis? Saat menarik napas itulah, sisa makanan masuk ke paru-paru. Akibatnya, setelah tersedak anak batuk-batuk. Mungkin setelah batuk ia akan tenang, tapi setelah 1-2 hari napasnya mulai bunyi. Bahkan bisa juga kemudian terjadi peradangan dalam paru-paru. Anak bisa panas karena terjadi infeksi. Yang sering adalah napas berbunyi seperti asma dan banyak lendir. Biasanya setelah dilakukan rontgen akan diketahui adanya penyumbatan/atelektasis. Pengobatan dapat dilakukan dengan bronkoskopi, dengan mengambil cairan atau makanan yang menyumbatnya. Selain makanan, akan lebih berbahaya bila aspirasi terjadi karena minyak tanah atau bensin, meski hanya satu teguk. Ini bisa terjadi karena kecerobohan orang tua yang menyimpan minyak tanah/bensin di dalam botol bekas minuman dan menaruhnya sembarangan. Bahayanya bila tersedak minyak ini, gas yang dihasilkan minyak ini akan masuk ke lambung dan menguap, kemudian masuk ke paru-paru, sehingga bisa merusak paru-paru. Akan sangat berbahaya pula kalau dimuntahkan, karena akan langsung masuk ke paru-paru. Jadi, kalau ada anak yang minum minyak tanah/bensin jangan berusaha dimuntahkan, tapi segera ke dokter. Oleh dokter, paru-parunya akan "dicuci" dengan alat bronkoskop.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi.</span></i><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Selain itu sesak napas pada bayi bisa terjadi karena penyakit infeksi. Bila anak mengalami ISPA (Infeksi saluran Pernapasan Akut) bagian atas, semisal flu harus ditangani dengan baik. Kalau tidak sembuh juga, misalnya dalam seminggu dan daya tahan anak sedang jelek, maka ISPA atas ini akan merembet ke ISPA bagian bawah, sehingga anak mengalami bronkitis, radang paru-paru, ataupun asmatik bronkitis. Gejalanya, anak gelisah, rewel, tak mau makan-minum, napas akan cepat, dan makin lama melemah. Biasanya juga disertai tubuh panas, sampai sekeliling bibir biru/sianosis, berarti pernapasannya terganggu. Penyebabnya ini akan diketahui dengan pemeriksaan dokter dan lebih jelasnya lagi dengan foto rontgen. Pengobatan dilakukan dengan pemberian antibiotika. Biasanya kalau bayi sudah terkena ISPA bawah harus dilakukan perawatan di rumah sakit. Setelah diobati,umumnya sesak napas akan hilang dan anak sembuh total tanpa meninggalkan sisa, kecuali bagi yang alergi. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Patofisiologi</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor yang memudahkan terjadinya RDS pada bayi prematur disebabkan oleh alveoli masih kecil sehingga sulit berkembang, pengembangan kurangsempurna karena dinding thorax masih lemah, produksi surfaktan kurang sempurna. Kekurangan surfaktan mengakibatkan kolaps pada alveolus sehingga paru-paru menjadi kaku. Hal tersebut menyebabkan perubahan fisiologi paru sehingga daya pengembangan paru (compliance) menurun 25 % dari normal, pernafasan menjadi berat, shunting intrapulmonal meningkat dan terjadi hipoksemia berat, hipoventilasi yang menyebabkan asidosis respiratorik. Telah diketahui bahwa surfaktan mengandung 90% fosfolipid dan 10% protein , lipoprotein ini berfungsi menurunkan tegangan permukaan dan menjaga agar alveoli tetap mengembang. Secara makroskopik, paru-paru tampak tidak berisi udara dan berwarna kemerahan seperti hati. Oleh sebab itu paru-paru memerlukan tekanan pembukaan yang tinggi untuk mengembang. Secara histologi, adanya atelektasis yang luas dari rongga udara bagian distal menyebabkan edem interstisial dan kongesti dinding alveoli sehingga menyebabkan desquamasi dari epithel sel alveoli type II. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dilatasi duktus alveoli, tetapi alveoli menjadi tertarik karena adanya defisiensi surfaktan ini. Dengan adanya atelektasis yang progresif dengan barotrauma atau volutrauma dan toksisitas oksigen, menyebabkan kerusakan pada endothelial dan epithelial sel jalan napas bagian distal sehingga menyebabkan eksudasi matriks fibrin yang berasal dari darah. Membran hyaline yang meliputi alveoli dibentuk dalam satu setengah jam setelah lahir. Epithelium mulai membaik dan surfaktan mulai dibentuk pada 36- 72 jam setelah lahir. Proses penyembuhan ini adalah komplek; pada bayi yang immatur dan mengalami sakit yang berat dan bayi yang dilahirkan dari ibu dengan chorioamnionitis sering berlanjut menjadi Bronchopulmonal Displasia (BPD).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Manifestasi <span> </span>klinis</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi dari RDS disebabkan adanya atelektasis alveoli, edema, dan kerusakan sel dan selanjutnya menyebabkan bocornya serum protein ke dalam alveoli sehingga menghambat fungsi surfaktan.Gejala klinis yang timbul yaitu : adanya sesak napas pada bayi prematur segera setelah lahir, yang ditandai dengan takipnea (> 60 x/menit), pernapasan cuping hidung, grunting, retraksi dinding dada, dan sianosis, dan gejala menetap dalam 48-96 jam pertama setelah lahir. Berdasarkan foto thorak, menurut kriteria Bomsel ada 4 stadium RDS yaitu :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stadium 1</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat sedikit bercak retikulogranular dan sedikit bronchogram udara</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stadium 2</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bercak retikulogranular homogen pada kedua lapangan paru dan gambaran airbronchogram udara terlihat lebih jelas dan meluas sampai ke perifer menutupi bayangan jantung dengan penurunan aerasi paru.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stadium 3</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kumpulan alveoli yang kolaps bergabung sehingga kedua lapangan paru terlihat lebih opaque dan bayangan jantung hampir tak terlihat, bronchogram udara lebih luas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stadium 4</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Seluruh thorax sangat opaque ( white lung ) sehingga jantung tak dapat dilihat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Insidens</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat korelasi terbalik antara insidens RDS dan usia kehamilan : semakin muda seorang bayi, semakin tinggi risiko RDS. Akan tetapi, tampaknya kasus-kasus RDS lebih bergantung pada kematangan paru dari pada usia gestasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di diagnosis pada 25 % bayi dengan usia gestasi 34 minggu dan 80 %<span> </span>bayi yang usia gestasinya kurang dari 28 minggu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keparahan RDS menurun pada bayi yang ibunya mendapatkan kortikosteroid<span> </span>24 – 48 jam sebelum pelahiran. Terapi steroid antenatal yang di kombinasikan dengan pemberian surfaktan pascanatal tampaknya memiliki efek aditif dalam meningkatkan fungsi paru.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RDS terjadi 2 X lebih banyak pada laki-laki dari pada perempuan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insidens meningkat pada bayi cukup bulan bila terdapat factor – factor tertentu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ibu diabetes yang melahirkan bayi dengan usia gestasi kurang dari 38 minggu.</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipoksia perinatal.</span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Komplikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi jangka pendek ( akut ) dapat terjadi :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ruptur alveoli</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila dicurigai terjadi kebocoran udara ( pneumothorak, pneumomediastinum, pneumopericardium, emfisema intersisiel ), pada bayi dengan RDS yang tiba2 memburuk dengan gejala klinis hipotensi, apnea, atau bradikardi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat timbul infeksi yang terjadi karena keadaan penderita yang memburuk dan adanya perubahan jumlah leukosit dan thrombositopeni. Infeksi dapat timbul karena tindakan invasiv seperti pemasangan jarum vena, kateter, dan alat respirasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan intrakranial dan leukomalacia periventrikular</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perdarahan intraventrikuler terjadi pada 20-40% bayi prematur dengan frekuensi terbanyak pada bayi RDS dengan ventilasi mekanik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PDA dengan peningkatan shunting dari kiri ke kanan merupakan komplikasi bayi dengan RDS terutama pada bayi yang dihentikan terapi surfaktannya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi jangka panjang yang sering terjadi :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bronchopulmonary Dysplasia (BPD)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">merupakan penyakit paru kronik yang disebabkan pemakaian oksigen pada bayi dengan masa gestasi 36 minggu. BPD berhubungan dengan tingginya volume dan tekanan yang digunakan pada waktu menggunakan ventilasi mekanik, adanya infeksi, inflamasi, dan defisiensi vitamin A. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retinopathy premature</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kegagalan fungsi neurologi, terjadi sekitar 10-70% bayi yang berhubungan dengan masa gestasi, adanya hipoxia, komplikasi intrakranial, dan adanya infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pemeriksaan diagnostic</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan AGD didapat adanya hipoksemia kemudian hiperkapni dengan asidosis respiratorik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan radiologis, mula-mula tidak ada kelainan jelas pada foto dada, setelah 12-24 jam akan tampak infiltrate alveolar tanpa batas yang tegas diseluruh paru</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biopsi paru , terdapat adanya pengumpulan granulosit secara abnormal dalam parenkim paru</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Terapi / penatalaksanaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberikan lingkungan yang optimal. Suhu tubuh bayi harus selalu diusahakan agar tetap dalam batas normal (36,5o-37oC) dengan cara meletakkan bayi dalam incubator. Kelembapan ruangan juga harus adekuat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemberian oksigen. Pemberian oksigen harus dilakukan dengan hati-hati karena berpengaruh kompleks pada bayi premature. pemberian oksigen yang terlalu banyak dapat menimbulkan komplikasi seperti fobrosis paru,dan kerusakan retina. Untuk mencegah timbulnya komplikasi pemberian oksigen sebaiknya diikuti dengan pemeriksaan analisa gas darah arteri. Bila fasilitas untuk pemeriksaan analisis gas darah arteri tidak ada, maka oksigen diberikan dengan konsentrasi tidak lebih dari 40% sampai gejala sianosis menghilang.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemberian cairan dan elektrolit sangat perlu untuk mempertahankan homeostasis dan menghindarkan dehidrasi. Pada permulaan diberikan glukosa 5-10% dengan jumlah yang disesuaikan dengan umur dan berat badan ialah 60-125 ml/kgBB/hari. Asidosis metabolic yang selalu dijumpai harus segera dikoreksi dengan memberikan NaHCO3 secara intravena yang berguna untuk mempertahankan agar pH darah 7,35-7,45. Bila tidak ada fasilitas untuk pemeriksaan analisis gas darah, NaHCO3 dapat diberi langsung melalui tetesan dengan menggunakan campuran larutan glukosa 5-10% dan NaHCO3 1,5% dalam perbandinagn 4:1</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemberian antibiotic. bayi dengan PMH perlu mendapat antibiotic untuk mencegah infeksi sekunder. dapat diberikan penisilin dengan dosis 50.000-100.000 U/kgBB/hari atau ampisilin 100 mg/kgBB/hari, dengan atau tanpa gentamisin 3-5 mg/kgBB/hari.</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemajuan terakhir dalam pengobatan pasien PMH adalah pemberian surfaktan eksogen (surfaktan dari luar). Obat ini sangat efektif tapi biayanya sangat mahal.</span></div><div class="MsoListParagraph" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>J.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pathway</span></b></div><div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"> </div><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Trauma</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Kelainan neurologis</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Gangguan syaraf pernapasan dan otot pernapasan</div></div></td> </tr>
</tbody></table><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"> </span></b> <div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"><br />
</div><br clear="ALL" style="color: lime;" /> <div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"> </div><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Peningkatan permeabilitas ,membrane alveolar kapiler</div></div></td> </tr>
</tbody></table><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<br />
</span> <div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"> </div><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Gangguan epithelium alveolar</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Gangguan endothelium alveolar</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Penumpukan cairan alveoli</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Cairan masuk ke interstitial</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Peningkatan tekanan jalan napas</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Edema pulmo</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Penurunan complain paru</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Kehilangan fungsi silia saluran pernapasan</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Cairan surfaktan menurun</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Bersihan jalan napas tidak efektif</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Gangguan pengembangan paru (atelaktasis)</div><div align="center" class="MsoNormal" style="text-align: center;">Kolaps alveoli</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Ventilasi dan perfusi tidak seimbang</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Gangguan pertukaran gas</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Hipoksemia ,hiperkopnia</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">O2<span> </span>CO2</div><div class="MsoNormal">Dispnea<span> </span>cyanosis</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Tindakan primer</div><div align="center" class="MsoNormal" style="text-align: center;">A, B, C, D, dan E</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div align="center" class="MsoNormal" style="text-align: center;">Ventilasi mekanik</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Resiko tinggi infeksi</div></div></td> </tr>
</tbody></table><table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div> <div class="MsoNormal">Resiko tinggi cedera</div></div></td> </tr>
</tbody></table><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b> <div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-left: 36pt; text-align: center; text-indent: -36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">ASUHAN KEPERAWATAN </span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">( RESPIRATORY DISTRESS SYNDROMA )</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pengkajian</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data subyetif Data obyektif Masalah</span><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sesak nafas (takipnea) Cyanosis, nafas cepat, tampak pucat, hasil pemeriksaan AGD <span> </span>PaO2 menurun, PaCO2 meningkat, PH menurun, kerusakan pertukaran gas</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dyspnea ada perubahan frekwensi nafas, terdengar ronchi hampir seluruh paru, tampak infiltrat alveolar Bersihan jalan nafas tidak efektif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gelisah, Resiko terhadap cedera</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Diagnosa keperawatan </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan pertukaran gas berhubungan dengan akumulasi protein dan cairan dalam interstisial / area alveolar ditandai dengan sesak nafas (takipnea), cyanosis, nafas cepat, tampak pucat, hasil AGD isi O2 menurun, PCO2 meningkat,PH menurun, PO2 menurun. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bersihan jalan nafas tidak efektif berhubungan dengan meningkatnya tahanan jalan nafas (edema interstisial) ditandai dengan dyspnea, ada perubahan frekwensi nafas,terdengar ronchi hampir seluruh paru, tampak infiltrat alveolar.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko terhadap cedera berhubungan dengan kurang kesadaran akan bahaya lingkungan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Rencana tindakan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan pertukaran gas berhubungan dengan akumulasi protein dan cairan dalam interstisial / area alveolar ditandai dengan sesak nafas (takipnea), cyanosis, nafas cepat, tampak pucat, hasil AGD isi O2 menurun, PCO2 meningkat,PH menurun, PO2 menurun. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><i><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : </span></u></i></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Setelah diberikan askep selama 3X24 jam diharapkan masalah pertukaran gas tertangani</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><i><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil : </span></u></i></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sesak nafas (-), ada perbaikan ventilasi dan oksigenasi yang adekuat dengan GDA dalam rentang normal Kaji status pernafasan dengan sering, catat peningkatan frekwensi/upaya pernafasan atau perubahan pola nafas. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Catat ada/tidaknya bunyi nafas tambahan seperti mengi, krekels.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bunyi napas dapat menurun, tidak sama atau tak ada pada area yang sakit. Krekels adalah bukti peningkatan cairan dalam area jaringan sebagai akibat peningkatan permeabilitas membrane alveolar – kapiler. Mengi adalah bukti konstriksi bronkus dan/atau penyempitan jalan napas sehubungan dengan mucus/edema.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji adanya cyanosis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penurunan oksigenasi bermakna (desaturasi 5 g hemoglobin) terjadi sebelum sianosis. Sianosis sentral dari ‘’ organ ‘’ hangat contoh lidah, bibir, dan daun telinga, adalah paling indikatif dari hipoksemia sistemik. Sianosis perifer kuku/ekstremitas sehubungan dengan vasokontriksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi kecendrungan tidur, apatis, tidak perhatian,gelisah, bingung, somnolen.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat menunjukan berlanjutnya hipoksemia dan / atau asidosis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Auskultasi frekwensi jantung dan irama.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipoksemia dapat menyebabkan mudah terangsang pada miokardium, menghasilkan berbagai distrimia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan oksigen lembab dengan masker CPAP sesuai indikasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memaksimalkan sediaan oksigen untuk pertukaran, dengan tekanan jalan napas positif continue.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu dengan/ berikan tindakan IPPB </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan ekspansi penuh paru untuk memperbaiki oksigenasi dan untuk memberikan obat nebulizer kedalam jalan napas. Intubasi dan dukungan ventilasi diberikan bila PaO2 kurang dari 60 mmHg dan tidak berespon terhadap peningkatan oksigen murni (FIP2)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Awasi/ gambarkan seri AGD/ oksimetri nadi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan ventilasi/oksigenasi dan status asam/basa. Digunakan sebagai dasar evaluasi keektifan terapi atau indicator kebutuhan perubahan terapi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan obat sesuai indikasi spt antibiotika, steroid, diuretik. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan untuk SDPD sangat mendukung lebih besar atau di buat untuk memperbaiki penyebab SDPD dan mencegah berlanjutnya<span> </span>dan potensial komplikasi fatal hipoksemia. Steroid menguntungkan dalam menurunkan inflamasi dan meningkatkan produksi surfaktan. Fungsi utama diuretik adalah untuk memobilisasi cairan udem, yang berarti mengubah keseimbangan cairan sedemikian rupa sehingga volume cairan ekstra sel kembali menjadi normal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bersihan jalan nafas tidak efektif berhubungan dengan meningkatnya tahanan jalan nafas (edema interstisial) ditandai dengan dyspnea, ada perubahan frekwensi nafas,terdengar ronchi hampir seluruh paru, tampak infiltrat alveolar.</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><i><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan :</span></u></i></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Setelah diberikan tindakan perawatan selama 3X24 jam diharapkan bersihan jalan napas efektif.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><i><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil :</span></u></i></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jalan napas paten dengan bunyi napas bersih/ tidak ada ronchi. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Catat perubahan upaya dan pola bernapas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengguanaan otot intercostals/abdominal dan pelebaran nasal menunjukan peningkatan upaya bernapas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi penurunan ekspansi dinding dada dan adanya/ peningkatan fremitus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ekspansi dada terbatas atau tidak sama sehubungan dengan akumulasi cairan, edema, dan secret dalam seksi lobus. Konsolidasi paru dan pengisian cairan dapat meningkatkan fremitus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Catat karakteristik bunyi napas</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bunyi napas menunjukan aliran udara melalui<span> </span>pohon trakeobronkial dan di pengaruhi oleh adanya cairan, mucus, atau obstruksi aliran udara lain. Mengi dapat merupakan bukti kontriksi bronkus atau penyempitan jalan napas sehubungan dengan edema . ronki dapat jelas tanpa batuk dan menunjukan pengumpulan mucus pada jalan napas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertahankan posisi tubuh/ kepala tepat dan gunakan alat jalan napas sesuai kebutuhan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memudahkan memelihara jalan napas atas paten bila jalan napas pasien dipengaruhi misalnya : gangguan tingkat kesadaran, sedasi, dan trauma maksilofasial</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi : berikan oksigen lembab, cairan IV, berikan kelembaban ruangan yang tepat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelembapan menghilangkan dan memobilisasi secret dan meningkatkan transport oksigen.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan Bronkodilator/ ekspektoran sesuai indikasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obat diberikan untuk menghilangkan spasme bronkus, menurunkan viskositas secret, memperbaiki ventilasi, dan memudahkan pembuangan secret.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko terhadap cedera berhubungan dengan kurang kesadaran akan bahaya lingkungan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><i><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan :</span></u></i></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Setelah diberikan tindakan perawatan selama 3X24 jam diharapkan tidak terjadi cedera </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><i><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil :</span></u></i></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi situasi yang mendukung kecelakaan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurangi/ hilangkan situasi yang berbahaya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menghindari cedera pada pasien</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasang pembatas pada tempat tidur Agar segala sesuatu yang dapat menimbulkan masalah/ berbahaya bagi klien dapat dihindari.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk menjaga/ menyangga klien agar tidak terjatuh. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Evaluasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil yang diharapkan:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien menunjukkan perbaikan ventilasi dan oksigenasi adekuat dengan AGD dalam rentang normal dan bebas gejala distres pernapasan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien menunjukkan/ menyatakan hilangnya dispnea, mampu mempertahankan jalan napas paten dengan bunyi napas bersih/ tidak ada ronchi.</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien terhindar dari bahaya lingkungan/ cedera.</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB IV</span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENUTUP</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Kesimpulan</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Respiratory Distress Syndrome (RDS) disebut juga Hyaline Membrane Disease (HMD), merupakan sindrom gawat napas yang disebabkan defisiensi surfaktan terutama pada bayi yang lahir dengan masa gestasi kurang. (Malloy & Freeman 2000).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RDS adalah gangguan pernafasan yang sering terjadi pada bayi premature dengan tanda-tanda takipnue (>60 x/mnt), retraksi dada, sianosis pada udara kamar, yang menetap atau memburuk pada 48-96 jam kehidupan dengan x-ray thorak yang spesifik (Stark,1986).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RDS adalah perkembangan yang imatur pada sistem pernafasan atau tidak adekuatnya jumlah surfaktan dalam paru. RDS dikatakan sebagai Hyaline Membrane Disesae (Suryadi, 2001).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RDS adalah suatu sindrom kegawatan pada pernafasan yang terdiri atas gejala dispneu, pernafasan cepat lebih dari 60 kali permenit, sianosis, merintih pada saat ekspirasi; terdapat retraksi pada suprasternal, interkostal dan epigastrium. Pada penyakit ini terjadi perubahan paru yaitu berupa pembentukan jaringan hialin pada membran paru yang rusak. Kerusakan pada paru timbul akibat kekurangan komponen surfaktan pulmonal. Surfaktan adalah suatu zat aktif yang memberikan pelumasan pada ruang antar alveoli sehingga dapat mencegah pergesekan dan timbulnya kerusakan pada alveoli yang selanjutnya akan mencegah terjadinya kolaps paru. (Yuliani, 2001)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">SARAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagi para pembaca, diharapkan dapat memetik pemahaman dari uraian yang dipaparkan diatas, dan dapat mengaplikasikannya dalam lingkungan masyarkat sehingga dapat mencegah terjadinya RDS</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagi mahasiswa, diharapkan agar terus menambah wawasan khususnya dalam bidang keperawatan.</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagi dosen pembimbing, diharapkan dapat memberi masukan, baik dalam proses penyusunan maupun dalam pemenuhan referensi untuk membantu kelancaran dan kesempurnaan pembuatan makalah kedepannya.</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1062"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang</span></b></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kematian adalah suatu proses yang dapat dikenal secara klinis pada seseorang melalui pengamatan terhadap perubahan yang terjadi pada tubuh mayat. Perubahan itu akan terjadi dari mulai terhentinya suplai oksigen. Manifestasinya akan dapat dilihat setelah beberapa menit, jam dan seterusnya. Dari kepustakaan yang ada, saat kematian seseorang belum dapat ditunjukan secara tepat karena tanda - tanda dan gejala setelah kematian sangat bervariasi. Hal ini karena tanda atau gejala yang ditunjukan sangat dipengaruhi oleh beberapa hal diantaranya, umur, kondisi fisik pasien, penyakit sebelumnya, keadaan lingkungan mayat, sebelumnya makanan maupun penyebab kematian itu sendiri. Dalam era ini dibutuhkan penentuan saat kematian secara tepat. </span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Selain itu salah satu penyebab asfiksia adalah persalinan dengan bedah caesar sangat tinggi risikonya terhadap bayi baru lahir yaitu kematian bayi, risiko gangguan pernafasan bayi, risiko trauma bayi dan risiko gangguan otak. Risiko yang dialami bayi baru lahir terkait persalinan dengan caesar adalah 3,5 kali lebih besar dibandingkan dengan persalinan normal ( Dr. Andon Hestiantoro SpOG ( K ) dari Departemen Obstetri dan Ginekologi FKUI/RSCM</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Anne Hansen dari Aarhus University Hospital, Denmark, mengatakan bahwa bayi yang lahir dengan seksio sesarea memiliki risiko lebih tinggi pada sistem pernafasan kemungkinan berkaitan dengan perubahan fisiologi akibat proses kelahiran. Proses kelahiran dengan seksio sesarea memicu pengeluaran hormon stres pada ibu yang diperkirakan menjadi kunci pematangan paru-paru bayi yang terisi air sehingga bayi lahir mengalami asfiksia. Asfiksia sendiri adalah kegagalan bayi untuk bernafas dan mempertahankannya. Selain dapat menimbulkan kematian, jika terlambat ditangani asfiksia bisa mengakibatkan cacat seumur hidup seperti buta, tuli, dan cacat otak.<span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut dr. Wayan Retayasa, SpA (K) dari RS Wangaya Bali,Angka Kematian Bayi akibat asfiksia di tingkat nasional berkisar 3 % dari 100 juta bayi yang lahir di negara berkembang sehingga perlu penanganan yang benar agar tidak menimbulkan kecacatan bayi dan gangguan pada tumbuh kembangnya di kemudian hari. Sementara sekitar 900.000 bayi di Indonesia lahir dengan asfiksia dan merupakan penyebab nomor dua kematian bayi.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gambaran singkat mengenai AKB, dimana AKB terdapat 32 kasus yaitu 16 kasus dikarenakan asfiksia, 1 kasus karena tetanus neonatorum, 2 kasus infeksi dan 13 kasus sisanya karena berbagai macam faktor. Menurut Helen Varney 2007, kejadian asfiksia pada bayi baru lahir dapat disebabkan oleh berbagai faktor diantaranya adalah dari faktor persalinan dengan tindakan yaitu persalinan dengan seksio sesarea. Hansen dan koleganya mempublikasikan British Medical Journal Online 11 desember 2007, yang meneliti lebih dari 34.000 kelahiran di Denmark. Mereka menemukan hampir 4 kali peningkatan risiko kesulitan bernafas pada bayi-bayi yang dilahirkan secara seksio sesarea. Sedangkan menurut Helen Varney 2007, neonatus yang dilahirkan dengan seksio sesarea, terutama jika tidak ada tanda persalinan, tidak mendapatkan manfaat dari pengeluaran cairan paru dan penekanan pada toraks sehingga mengalami gangguan pernafasan yang lebih persistan.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kompresi toraks janin pada persalinan kala II mendorong cairan untuk keluar dari saluran pernafasan. Sander 1978 menemukan bahwa tekanan yang agak besar seiring dengan ditimbulkan oleh kompresi dada pada kelahiran pervaginam dan di perkirakan bahwa cairan paru-paru yang didorong setara dengan seperempat kapasitas residual fungsional. Jadi, pada bayi yang lahir dengan seksio sesarea mengandung cairan lebih banyak dan udara lebih sedikit di dalam parunya selama 6 jam pertama setelah lahir ( Milner dkk, 1978 ). Kompresi toraks yang menyertai kelahiran pervagainam dan ekspansi yang mengikuti kelahiran, mungkin merupakan suatu faktor penyokong pada inisiasi respirasi ( Obstetri Williams edisi 21, 2005 ).<span> </span><br />
Dari studi pendahuluan Di Rumah Sakit pada tahun 2005 terdapat 741 bayi yang dilahirkan dengan persalinan seksio sesarea. Dari persalinan seksio sesarea terdapat 39 bayi yang mengalami asfiksia. Sedangkan periode bulan Agustus sampai September 2009 terdapat 184 kelahiran, dimana kelahiran seksio sesarea sebanyak 130 kelahiran dan 52 kelahiran normal sedangkan sisanya kelahiran dengan tindakan vacum. Dari 130 kelahiran dengan cara seksio sesarea terdapat 8 bayi yang mengalami gangguan pernafasan sedangkan pada 52 kelahiran normal terdapat 2 bayi yang mengalami gangguan sistem pernafasan.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rumusan masalah</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila dilihat dari angka kejadian diatas, asfiksia pada bayi baru lahir masih cukup tinggi, penulis tertarik untuk mengetahui lebih dalam tentang asfiksia.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify; text-indent: 13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di harapkan mahasiswa dapat memberikan asuhan keperawatan pasda bayi asfiksia.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;"> </span></b> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">PEMBAHASAN</span></b></div><ol start="1" style="margin-top: 0cm;" type="A"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengertian </span></b></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia adalah keadaan dimana bayi baru lahir tidak dapat bernapas secara spontan dan teratur. Bayi dengan riwayat gawat janin sebelum lahir, umumnya akan mengalami asfiksia pada saat dilahirkan. Masalah ini erat hubungannya dengan gangguan kesehatan ibu hamil, kelainan tali pusat, atau masalah yang mempengaruhi kesejahteraan bayi selama atau sesudah persalinan. (Noname: Online)</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia neonatorum ialah <span class="fullpost">keadaan dimana bayi tidak dapat segera bernafas secara spontan dan teratur setelah lahir. Hal ini disebabkan oleh hipoksia janin dalam uterus dan hipoksia ini berhubungan dengan faktor-faktor yang timbul dalam kehamilan, persalinan, atau segera setelah bayi lahir. Akibat-akibat asfiksia akan bertambah buruk apabila penanganan bayi tidak dilakukan secara sempurna. Tindakan yang akan dikerjakan pada bayi bertujuan mempertahankan kelangsungan hidupnya dan membatasi gejala-gejala lanjut yang mungkin timbul. (Prawirohardjo: 1991).</span></span></div><ol start="2" style="margin-top: 0cm;" type="A"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi</span></b></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia janin atau neonatus akan terjadi jika terdapat gangguan perlukaran gas atau pengangkutang O2 dari ibu kejanin. Gangguan ini dapat timbul pada masa kehamilan, persalinan atau segera setelah lahir. Hampir sehagian hes;ir asfiksia bayi baru lahir merupakan kelanjutan asfiksia janin, karena itu penilaian janin selama kehamilan dan persalinan. memegang peran penting untuk keselamatan bayi atau kelangsungan hidup yang sempurna tanpa gejala sisa.<span> </span><br />
Pengolongan penyebab kegagalan pernafasan pada bayi terdiri dari:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor Ibu <span> </span><br />
a. Hipoksia ibu</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadi karena hipoventilasi akibat pemberian obat analgetika atau anestesia dalam. Hal ini akan menimbulkan hipoksia janin. </span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Gangguan aliran darah uterus</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengurangnya aliran darah pada uterus akan menyebabkan berkurangnya pengaliran oksigen ke plasenta dan kejanin. Hal ini sering ditemukan pada :</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ganguan kontraksi uterus, misalnya hipertoni, hipotoni atau tetani uterus akibat penyakit atau obat.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipotensi mendadak pada ibu karena perdarahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi pada penyakit akiomsia dan lain-lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor plasenta</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertukaran gas antara ibu dan janin dipengaruhi oleh luas dan kondisi plasenta. Asfiksia janin akan terjadi bila terdapat gangguan mendadak pada plasenta, misalnya solusio plasenta, perdarahan plasenta dan lain-lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor fetus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kompresi umbilikus akan mengakibatkan terganggunya aliran darah dalam pembuluh darah umbilikus dan menghambat pertukaran gas antara ibu dan janin. Gangguan aliran darah ini dapat ditemukan pada keadaan : tali pusat menumbung, tali pusat melilit leher kompresi tali pusat antar janin dan jalan lahir dan lain-lain. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor Neonatus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Depresi pusat pernapasan pada bayi baun lahir dapat terjadi karena :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pemakaian obat anestesia/analgetika yang berlebihan pada ibu secara langsung dapat menimbulkan depresi pusat pernafasan janin.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Trauma yang terjadi pada persalinan, misalnya perdarah intrakranial. Kelainan konginental pada bayi, misalnya hernia diafrakmatika atresia/stenosis saluran pernafasan, hipoplasia paru dan lain-lain.</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patofisiologi</span></b></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -45pt;"><span style="height: 54px; left: 0px; margin-left: 282px; margin-top: 14px; position: absolute; width: 12px; z-index: 251668480;"><img height="54" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="12" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Persalinan lama, lilitan tali pusat<span> </span>Paralisis pusat pernafasan<span> </span>factor lain : anestesi,</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -45pt;"><span style="height: 26px; left: 0px; margin-left: 71px; margin-top: 16px; position: absolute; width: 2px; z-index: 251665408;"><img height="26" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="2" /></span><span style="height: 26px; left: 0px; margin-left: 503px; margin-top: 16px; position: absolute; width: 2px; z-index: 251667456;"><img height="26" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.gif" width="2" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Presentasi janin abnormal<span> </span>obat-obatan narkotik</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -45pt;"><span> <table align="left" cellpadding="0" cellspacing="0"><tbody>
<tr> <td height="6" width="71"><br />
</td> </tr>
<tr> <td><br />
</td> <td><img height="2" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.gif" width="434" /></td> </tr>
</tbody></table></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><br clear="ALL" /> <div align="center" class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: center; text-indent: -45pt;"><span style="height: 27px; left: 0px; margin-left: 65px; margin-top: 16px; position: absolute; width: 12px; z-index: 251670528;"><img height="27" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="12" /></span><span style="height: 27px; left: 0px; margin-left: 497px; margin-top: 16px; position: absolute; width: 12px; z-index: 251671552;"><img height="27" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.gif" width="12" /></span><span style="height: 2px; left: 0px; margin-left: 70px; margin-top: 16px; position: absolute; width: 434px; z-index: 251669504;"><img height="2" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image005.gif" width="434" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ASFIKSIA</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21pt;"><span style="height: 32px; left: 0px; margin-left: 474px; margin-top: 14px; position: absolute; width: 12px; z-index: 251689984;"><img height="32" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image006.gif" width="12" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Janin kekurangan O2<span> </span>paru-paru terisi cairan </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: 36pt;"><span style="height: 14px; left: 0px; margin-left: 119px; margin-top: 13px; position: absolute; width: 2px; z-index: 251674624;"><img height="14" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image007.gif" width="2" /></span><span style="height: 134px; left: 0px; margin-left: 539px; margin-top: 1px; position: absolute; width: 2px; z-index: 251692032;"><img height="134" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image008.gif" width="2" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Dan kadar CO2 meningkat</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21pt; text-align: justify;"><span style="height: 79px; left: 0px; margin-left: 430px; margin-top: 7px; position: absolute; width: 115px; z-index: 251691008;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td bgcolor="white" height="79" style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: white none repeat scroll 0% 0%; border: 0.5pt solid black; vertical-align: top;" width="116"><span style="left: 0pt; position: absolute; z-index: 251691008;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div class="shape" style="padding: 4.35pt 7.95pt;"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Bersihan jln nafas tidak efektif</div></div></td> </tr>
</tbody></table></span> </td> </tr>
</tbody></table></span><span style="height: 68px; left: 0px; margin-left: 306px; margin-top: 7px; position: absolute; width: 12px; z-index: 251684864;"><img height="68" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image009.gif" width="12" /></span><span style="height: 68px; left: 0px; margin-left: 198px; margin-top: 7px; position: absolute; width: 12px; z-index: 251680768;"><img height="68" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image009.gif" width="12" /></span><span style="height: 2px; left: 0px; margin-left: 35px; margin-top: 7px; position: absolute; width: 278px; z-index: 251672576;"><img height="2" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image010.gif" width="278" /></span><span style="height: 38px; left: 0px; margin-left: 30px; margin-top: 7px; position: absolute; width: 12px; z-index: 251673600;"><img height="38" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image011.gif" width="12" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 32px; margin-left: 474px; margin-top: 26px; position: absolute; width: 12px; z-index: 251693056;"><img height="32" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image006.gif" width="12" /></span><span style="height: 67px; margin-left: 30px; margin-top: 13px; position: absolute; width: 12px; z-index: 251675648;"><img height="67" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image012.gif" width="12" /></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nafas cepat</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 27px; margin-left: 306px; margin-top: 15px; position: absolute; width: 12px; z-index: 251685888;"><img height="27" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image013.gif" width="12" /></span><span style="height: 27px; margin-left: 198px; margin-top: 15px; position: absolute; width: 12px; z-index: 251662336;"><img height="27" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image013.gif" width="12" /></span><span style="height: 67px; margin-left: 70px; margin-top: 6px; position: absolute; width: 104px; z-index: 251679744;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td bgcolor="white" height="67" style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: white none repeat scroll 0% 0%; border: 0.5pt solid black; vertical-align: top;" width="105"><span style="position: absolute; z-index: 251679744;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div class="shape" style="padding: 4.35pt 7.95pt;"> <div align="center" class="MsoNormal" style="text-align: center;">Pola nafas tak efektif</div></div></td> </tr>
</tbody></table></span> </td> </tr>
</tbody></table></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span><span> </span>suplai O2<span> </span><span> </span>suplai O2<span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 59px; margin-left: 306px; margin-top: 18px; position: absolute; width: 12px; z-index: 251661312;"><img height="59" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image014.gif" width="12" /></span><span style="height: 59px; margin-left: 198px; margin-top: 18px; position: absolute; width: 12px; z-index: 251681792;"><img height="59" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image014.gif" width="12" /></span><span lang="DE" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Ke paru<span> </span><span> </span>dlm darah<span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 154px; margin-left: 35px; margin-top: 3px; position: absolute; width: 79px; z-index: 251678720;"><img height="154" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image015.gif" width="79" /></span><span lang="DE" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>perubahan asam<span> </span><span> </span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 79px; margin-left: 265px; margin-top: 16px; position: absolute; width: 140px; z-index: 251686912;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td bgcolor="white" height="79" style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: white none repeat scroll 0% 0%; border: 0.5pt solid black; vertical-align: top;" width="141"><span style="position: absolute; z-index: 251686912;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div class="shape" style="padding: 4.35pt 7.95pt;"> <div align="center" class="MsoNormal" style="text-align: center;">Resiko ketdkseimbangn suhu tubuh</div></div></td> </tr>
</tbody></table></span> </td> </tr>
</tbody></table></span><span style="position: relative; z-index: 251694080;"><span style="height: 64px; left: 474px; position: absolute; top: -1px; width: 12px;"><img height="64" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image016.gif" width="12" /></span></span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Apneu<span> </span><span> </span></span><span lang="DE" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan otak</span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 72px; margin-left: 198px; margin-top: 0px; position: absolute; width: 12px; z-index: 251663360;"><img height="72" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image017.gif" width="12" /></span><span style="height: 108px; margin-left: 30px; margin-top: 0px; position: absolute; width: 12px; z-index: 251676672;"><img height="108" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image018.gif" width="12" /></span><span lang="DE" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span lang="DE" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 26px; margin-left: 482px; margin-top: 21px; position: absolute; width: 12px; z-index: 251696128;"><img height="26" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image019.gif" width="12" /></span><span style="height: 71px; margin-left: 314px; margin-top: 4px; position: absolute; width: 12px; z-index: 251687936;"><img height="71" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image020.gif" width="12" /></span><span lang="DE" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">G3 perfusi ventilasi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 114px; margin-left: 30px; margin-top: 24px; position: absolute; width: 12px; z-index: 251660288;"><img height="114" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image021.gif" width="12" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DJJ & TD</span><span style="height: 67px; margin-left: 430px; margin-top: 4px; position: absolute; width: 140px; z-index: 251697152;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td bgcolor="white" height="67" style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: white none repeat scroll 0% 0%; border: 0.5pt solid black; vertical-align: top;" width="141"><span style="position: absolute; z-index: 251697152;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div class="shape" style="padding: 4.35pt 7.95pt;"> <div align="center" class="MsoNormal" style="text-align: center;">Kerusakan pertukaran gas</div></div></td> </tr>
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</tbody></table></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 33px; margin-left: 35px; margin-top: 19px; position: absolute; width: 151px; z-index: 251664384;"><img height="33" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image022.gif" width="151" /></span><span style="height: 51px; margin-left: 320px; margin-top: 19px; position: absolute; width: 12px; z-index: 251695104;"><img height="51" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image023.gif" width="12" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Asidosis respiratorik </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span><span> </span><span> </span>Kematian</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>bayi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="position: relative; z-index: 251698176;"><span style="height: 55px; left: 287px; position: absolute; top: -1px; width: 79px;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td bgcolor="white" height="55" style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: white none repeat scroll 0% 0%; border: 0.5pt solid black; vertical-align: top;" width="80"><span style="position: absolute; z-index: 251698176;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div class="shape" style="padding: 4.35pt 7.95pt;"> <div align="center" class="MsoNormal" style="text-align: center;">Resiko cedera</div></div></td> </tr>
</tbody></table></span> </td> </tr>
</tbody></table></span></span><span style="height: 63px; margin-left: 198px; margin-top: 10px; position: absolute; width: 12px; z-index: 251682816;"><img height="63" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image024.gif" width="12" /></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Janin tdk bereaksi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="height: 55px; margin-left: 145px; margin-top: 50px; position: absolute; width: 140px; z-index: 251683840;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td bgcolor="white" height="55" style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: white none repeat scroll 0% 0%; border: 0.5pt solid black; vertical-align: top;" width="141"><span style="position: absolute; z-index: 251683840;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div class="shape" style="padding: 4.35pt 7.95pt;"> <div align="center" class="MsoNormal" style="text-align: center;">Proses keluarga terhenti</div></div></td> </tr>
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</tbody></table></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terhadap rangsangan</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span><span> </span><span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -21.8pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi klinis</span></b></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia biasanya merupakan akibat dari hipoksi janin yang menimbulkan tanda:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DJJ lebih dari 1OOx/mnt/kurang dari lOOx/menit tidak teratur</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mekonium dalam air ketuban pada janin letak kepala </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apnea</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pucat </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sianosis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penurunan terhadap stimulus.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insiden asfiksia</span></b></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Korban kematian akibat asfiksia termasuk yang sering diperiksa oleh dokter. Umumnya urutan ke-3 sesudah kecelakaan lalu - lintas dan trauma mekanik.</span></div><ol start="6" style="margin-top: 0cm;" type="A"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi</span></b></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi yang muncul pada asfiksia neonatus antara lain :</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Edema otak & Perdarahan otak<span> </span></span></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: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada penderita asfiksia dengan gangguan fungsi jantung yang telah berlarut sehingga terjadi renjatan neonatus, sehingga aliran darah ke otak pun akan menurun, keadaaan ini akan menyebabkan hipoksia dan iskemik otak yang berakibat terjadinya edema otak, hal ini juga dapat menimbulkan perdarahan otak.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anuria atau oliguria<span> </span></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Disfungsi ventrikel jantung dapat pula terjadi pada penderita asfiksia, keadaan ini dikenal istilah disfungsi miokardium pada saat terjadinya, yang disertai dengan perubahan sirkulasi. Pada keadaan ini curah jantung akan lebih banyak mengalir ke organ seperti mesentrium dan ginjal. Hal inilah yang menyebabkan terjadinya hipoksemia pada pembuluh darah mesentrium dan ginjal yang menyebabkan pengeluaran urine sedikit.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada bayi yang mengalami asfiksia akan mengalami gangguan pertukaran gas dan transport O2 sehingga penderita kekurangan persediaan O2 dan kesulitan pengeluaran CO2 hal ini dapat menyebabkan kejang pada anak tersebut karena perfusi jaringan tak efektif.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Koma</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apabila pada pasien asfiksia berat segera tidak ditangani akan menyebabkan koma karena beberapa hal diantaranya hipoksemia dan perdarahan pada otak.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meliputi berbagai organ yaitu:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Otak : Hipokstik iskemik ensefalopati, edema serebri, palsi serebralis.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jantung dan paru: Hipertensi pulmonal persisten pada neonatorum, perdarahan paru, edema paru.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gastrointestinal: enterokolitis, nekrotikans.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ginjal: tubular nekrosis akut.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hematologi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan diagnostic</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Analisa gas darah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penilaian APGAR score</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan EGC dab CT- Scan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian spesifik</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Elektrolit darah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gula darah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Baby gram</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">USG ( Kepala)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan darah Kadar As. Laktat. kadar bilirubin, kadar PaO2, PH</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan asfiksia</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tindakan Umum </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bersihkan jalan nafas : kepala bayi dileakkan lebih rendah agar lendir mudah mengalir, bila perlu digunakan larinyoskop untuk membantu penghisapan lendir dari saluran nafas ayang lebih dalam.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rangsang reflek pernafasan : dilakukan setelah 20 detik bayi tidak memperlihatkan bernafas dengan cara memukul kedua telapak kaki menekan tanda achiles.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan suhu tubuh. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tindakan khusus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia berat<span> </span><br />
Berikan O2 dengan tekanan positif dan intermiten melalui pipa endotrakeal. dapat dilakukan dengan tiupan udara yang telah diperkaya dengan O2. Tekanan O2 yang diberikan tidak 30 cm H 20. Bila pernafasan spontan tidak timbul lakukan message jantung dengan ibu jari yang menekan pertengahan sternum 80 –100 x/menit.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia sedang/ringan<span> </span><br />
Pasang relkiek pernafasan (hisap lendir, rangsang nyeri) selama 30-60 detik. Bila gagal lakukan pernafasan kodok (Frog breathing) 1-2 menit yaitu : kepala bayi ektensi maksimal beri Oz 1-2 1/mnt melalui kateter dalam hidung, buka tutup mulut dan hidung serta gerakkan dagu ke atas-bawah secara teratur 20x/menit dan Penghisapan cairan lambung untuk mencegah regurgitasi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">KONSEP KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGKAJIAN </span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biodata </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas klien </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas orang tua</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ayah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ibu</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan sekarang</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluhan utama</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat keuhan utama</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan lalu</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prenatal care </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Natal </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Post natal </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirkulasi</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nadi apikal dapat berfluktuasi dari 110 sampai 180 x/mnt. Tekanan darah 60 sampai 80 mmHg (sistolik), 40 sampai 45 mmHg (diastolik).</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bunyi jantung, lokasi di mediasternum dengan titik intensitas maksimal tepat di kiri dari mediastinum pada ruang intercosta III/ IV.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Murmur biasa terjadi di selama beberapa jam pertama kehidupan.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tali pusat putih dan bergelatin, mengandung 2 arteri dan 1 vena.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Eliminasi</span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat berkemih saat lahir.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Makanan/ cairan</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat badan : 2500-4000 gram</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Panjang badan : 44-45 cm</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Turgor kulit elastis (bervariasi sesuai gestasi)</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Neurosensori</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tonus otot : fleksi hipertonik dari semua ekstremitas.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sadar dan aktif mendemonstrasikan refleks menghisap selama 30 menit pertama setelah kelahiran (periode pertama reaktivitas). Penampilan asimetris (molding, edema, hematoma).</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menangis kuat, sehat, nada sedang (nada menangis tinggi menunjukkan abnormalitas genetik, hipoglikemi atau efek narkotik yang memanjang)</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pernafasan</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skor APGAR : 1 menit......5 menit....... skor optimal harus antara 7-10.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rentang dari 30-60 permenit, pola periodik dapat terlihat.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bunyi nafas bilateral, kadang-kadang krekels umum pada awalnya silindrik thorak kartilago xifoid menonjol, umum terjadi.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keamanan</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suhu rentang dari 36,5º C sampai 37,5º C. Ada verniks (jumlah dan distribusi tergantung pada usia gestasi).</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kulit : lembut, fleksibel, pengelupasan tangan/ kaki dapat terlihat, warna merah muda atau kemerahan, mungkin belang-belang menunjukkan memar minor</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: 3pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(misal : kelahiran dengan forseps), atau perubahan warna herlequin, petekie pada kepala/ wajah (dapat menunjukkan peningkatan tekanan berkenaan dengan kelahiran atau tanda nukhal), bercak portwine, nevi telengiektasis (kelopak mata, antara alis mata, atau pada nukhal) atau bercak mongolia (terutama punggung bawah dan bokong) dapat terlihat. Abrasi kulit kepala mungkin ada (penempatan elektroda internal)</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DIAGNOSA KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bersihan jalan nafas tidak efektif b.d produksi mukus banyak</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penurunan cardiac out put berhubungan dengan edema paru</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola nafas tidak efektif b.d hipoventilasi/ hiperventilasi</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan pertukaran gas b.d ketidakseimbangan perfusi ventilasi.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan perfusi jaringan berhubungan dengan adanya hipovolemia</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko ketidakseimbangan suhu tubuh b.d kurangnya suplai O2 dalam darah.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RENCANA INTERVENSI</span></b></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DP 2: Bersihan jalan nafas tidak efektif b.d produksi mukus banyak.</span></b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span class="fullpost">Tujuan : Setelah dilakukan tindakan keperawatan selama proses keperawatan diharapkan jalan nafas lancar.<span> </span></span><br />
<span class="fullpost">Kriteria Hasil :</span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mudah dalam bernafas.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak adanya sianosis.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PaCO2 dalam batas normal.</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keseimbangan perfusi ventilasi</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intevensi :</span></b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tentukan kebutuhan oral/ suction tracheal.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/untuk meentukan tindakan keperawatan yang tepat</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Auskultasi suara nafas sebelum dan sesudah suction .</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/untuk mengetahui perubahan pernafasan sesudah dan sebelum suction</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beritahu keluarga tentang suction.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/menambah pengetahuan agar keluarga tidak cemas</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor status oksigen pasien, status hemodinamik segera sebelum, selama dan sesudah suction.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/oksigen pasien dalam keadaan statis</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resusitasi<span> </span>Neonatus:</span></b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Siapkan perlengkapan resusitasi sebelum persalinan.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tes resusitasi bagian suction dan aliran O2 untuk memastikan dapat berfungsi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">dengan baik.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tempatkan BBL di bawah lampu pemanas radiasi.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Masukkan laryngoskopy untuk memvisualisasi trachea untuk menghisap</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span class="fullpost">mekonium.Intubasi dengan endotracheal untuk mengeluarkan mekonium </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dari jalan nafas bawah.Berikan stimulasi taktil pada telapak kaki atau punggung bayi.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor respirasi.</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan auskultasi untuk memastikan vetilasi adekuat.</span></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: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DP 2<span> </span>: Penurunan cardiac out put berhubungan dengan edema paru.</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span class="fullpost">Tujuan<span> </span>: Menunjukan curah jantung dalam batas normal<span> </span></span><br />
<span class="fullpost">Kriteria hasil:</span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan warna kulit yang normal</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Edema perifer tidak ada</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bunyi nafas tambahan tidak ada</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Distensi vena leher tidak ada</span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitoring jantung paru </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/untuk mengetahui </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengkaji tanda vital</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/untuk memonitor kerja jantung apakah telah berfungsi dengan baik.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memonitor perfusi jaringan tiap 2-4 jam</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/kebutuhan jaringan terpenuhi</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memonitor denyut nadi</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/menunjukkan kerja jantung</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam pemberian vasodilator</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/agar pembuluh darah dapat berdilatasi dan dapat mengalirkan oksigen dengan baik yang ada dalam darah.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DP 3<span> </span>: Pola nafas tidak efektif b.d hipoventilasi/ hiperventilasi<span> </span></span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span></b><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan<span> </span>: Setelah dilakukan tindakan keperawatan selama proses keperawatan diharapkan pola nafas menjadi efektif.<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span class="fullpost">Kriteria hasil :</span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien menunjukkan pola nafas yang efektif.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ekspansi dada simetris.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ada bunyi nafas tambahan.</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecepatan dan irama respirasi dalam batas normal.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 9pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertahankan kepatenan jalan nafas dengan melakukan </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span class="fullpost">pengisapan lendir.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">membebaskan jalan nafas</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau status pernafasan dan oksigenasi sesuai dengan kebutuhan.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/kebutuhan oksigen terpenuhi<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Auskultasi jalan nafas untuk mengetahui adanya penurunan ventilasi.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/mengetahui keefektifan jalan<span> </span>nafas<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan dokter untuk pemeriksaan AGD dan pemakaian alat bantu<span> </span>nafas</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/alat bantu nafas dapat mengefektifkan pernafasan<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan oksigenasi sesuai kebutuhan.</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/agar kebutuhan oksigen terpenuhi<span> </span></span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DP 4: Kerusakan pertukaran gas b.d ketidakseimbangan perfusi ventilasi.<span> </span></span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span></b><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : Setelah dilakukan tindakan keperawatan selama proses keperawatan diharapkan pertukaran gas teratasi.<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span class="fullpost">Kriteria hasil :</span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak sesak nafas</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi paru dalam batas normal</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :<span> </span></span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji bunyi paru, frekuensi nafas, kedalaman nafas dan produksi sputum.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/mengetahui kelainan nafas pada bayi<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau saturasi O2 dengan oksimetri</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/mengetahui kosentrasi oksigen<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau hasil Analisa Gas Darah</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/Sbagai pemeriksaan penunjang<span> </span></span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DP 5: Gangguan perfusi jaringan berhubungan dengan adanya hipovolemia</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span></b><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan:</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">Menunjukan peningkatan perfusi sesuai secara individual</span><br />
<span class="fullpost">Kriteri hasil:</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Status mental dalam keadaan normal</span></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: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.Irama jantung dan nadi perifer dalam batas normal</span></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: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.Tidak ada sianosis sentral atau perifer</span></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: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.Kulit hangat </span></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: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.Keluaran urine dan berat jenis dalam batas normal</span></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: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:</span></b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan output yang normal dengan cara mempertahankan intake dan output.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/untuk keseimbangan antara intake dan output</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam pemberian diuretik sesuai indikasi</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/diuretic membantu pengontrolan output</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memonitor laboratorium urine lengkap</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/sebagai pedoman dalam melakukan tindakan yang tepat<span> </span></span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DP 6 : Risiko ketidakseimbangan suhu tubuh b.d kurangnya suplai O2 dalam darah.</span></b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span class="fullpost">Tujuan : Setelah dilakukan tindakan keperawatan selama proses keperawatan diharapkan suhu tubuh normal.<span> </span></span><br />
<span class="fullpost">Kriteria Hasil :<span> </span></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Temperatur badan dalam batas normal.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak terjadi distress pernafasan.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak gelisah.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan warna kulit.</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bilirubin dalam batas normal.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hindarkan pasien dari kedinginan dan tempatkan pada lingkungan yang hangat.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/untuk menghindarkan bayi dari hipothermi<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor gejala yang berhubungan dengan hipotermi, misal fatigue, apatis, perubahan warna kulit dll.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>R/untuk meminimalkan resiko terjadinya hipotermi</span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor temperatur dan warna kulit.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/memudahkan untuk mendeteksi bayi hipothermi</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor TTV.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/bayi sangat rentan kehilangan panas<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor adanya bradikardi.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/memantau adanya masalah dalam pernafasan</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor status pernafasan.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/mengetahui pernafasan tetap dalam keadaan normal<span> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor temperatur BBL setiap 2 jam sampai suhu stabil.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/untuk memantau suhu bayi tetap dalam keadaan stabil</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tempatkan BBL pada inkubator bila perlu.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/untuk menjaga kestabilan suhu bayi.<span> </span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">EVALUASI</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi dapat bernafas secara normal,curah jantung dalam batas normal serta keseimbangan suhu bayi terjaga dan bayi tidak menunjukkan tanda-tanda hipotermi/hipertermi.</span></div><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;"><br clear="all" style="page-break-before: always;" /> </span></b> <div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB IV</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENUTUP</span></b></div><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">KESIMPULAN</span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia adalah keadaan dimana bayi baru lahir tidak dapat bernapas secara spontan dan teratur. Bayi dengan riwayat gawat janin sebelum lahir, umumnya akan mengalami asfiksia pada saat dilahirkan. Masalah ini erat hubungannya dengan gangguan kesehatan ibu hamil, kelainan tali pusat, atau masalah yang mempengaruhi kesejahteraan bayi selama atau sesudah persalinan. (Noname: Online) Etiologi</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asfiksia janin atau neonatus akan terjadi jika terdapat gangguan perlukaran gas atau pengangkutang O2 dari ibu kejanin. Gangguan ini dapat timbul pada masa kehamilan, persalinan atau segera setelah lahir. Hampir sehagian hes;ir asfiksia bayi baru lahir merupakan kelanjutan asfiksia janin, karena itu penilaian janin selama kehamilan dan persalinan. memegang peran penting untuk keselamatan bayi atau kelangsungan hidup yang sempurna tanpa gejala sisa.<span> </span><br />
Pengolongan penyebab kegagalan pernafasan pada bayi terdiri dari:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor Ibu <span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan aliran darah uterus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor plasenta</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor fetus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor Neonatus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">SARAN</span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penulis berharap pembaca dapat mengambil pelajaran dan<span> </span>menambah wawasan dari makalah yang kami buat.</span></div><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">DAFTAR PUSTAKA</span></div><div style="margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="color: black;">Purnawan J, DKK.(1989). <i>Kapita Selekta Kedokteran</i>. Edisi 2. Jakarta : media </span><span> </span><span style="color: black;">aeusculapius FKUI</span></div><div style="margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="color: black;">Staf pengajar IKA FKUI. ( 1995 ). <i>Ilmu Kesehatan Anak</i>. Jilid 3. Jakarta : IKA </span><span class="fullpost"><span style="font-size: 11pt;">01 december 2010, 04:00 pm,</span>Straight. B. R. 2004. Keperawatan Ibu Baru Lahir. Edisi 3. Jakarta : EGC</span><br />
<span class="fullpost">terdapat pada </span><a href="http://www.freewebs.com/asfiksia/polacederaasfiksia.htm">http://www.freewebs.com/asfiksia/polacederaasfiksia.htm</a></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-12041541087345502302011-02-22T02:42:00.000-08:002011-02-22T02:45:47.771-08:00Askep TBC pada Anak<div style="color: magenta;"><m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><b><span style="font-size: 14pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><b><span style="font-size: 14pt; line-height: 150%;">PENDAHULUAN </span></b></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><br />
</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><b>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Latar Belakang</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Siapa yang tidak kenal dengan tuberkulosis (TB). Penyakit ini kian populer dalam beberapa waktu dengan slogan baru yang disandangnya, “TB: Bukan Batuk Biasa”. Beberapa orang awam mungkin lebih mengenalnya dengan sebutan penyakit flek paru.<b> </b>Tak disangka, TB ternyata adalah penyakit usang yang sudah ditemukan sejak jaman Mesir kuno. Meski usang, tapi penyakit ini masih belum bisa juga dibasmi di muka bumi. Sampai-sampai, TB pun memiliki hari peringatan sedunia yang jatuh setiap tanggal 24 Maret. Dengan adanya hari peringatan itu, tentu diharapkan dunia aware terhadap penyakit ini.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">TB bukanlah penyakit yang hanya dapat diderita orang dewasa. Anak-anak pun terancam. Anak sangat rentan selama tahun pertama dari tiga tahun kehidupan selama dan segera setelah pubertas. Baru-baru ini, jumlah kasus TB semakin meningkat, banyak yang tercatat, terutama kaum gelandangan, pada kelompok masyarakat berpendapatan rendah, dan mereka yang terinfeksi kuman HIV. Organisasi Kesehatan Dunia (WHO) melaporkan terdapat lebih dari 250.000 anak menderita TB dan 100.000 di antaranya meninggal dunia. Disinilah masalah mulai muncul. Insiden yang terus merangkak tidak disertai dengan kemudahan menegakkan diagnosis sedini mungkin. Demikian papar Prof Dr. dr. Cissy B Kartasasmita, SpA(K) dalam The 2007 National Symposium Update on Tuberculosis and Respiratory Disorders, Bandung, 23-25 Maret 2006. Pada orang dewasa, diagnosis pasti ditegakkan apabila menemukan kuman M. tuberculosis dalam sputum/dahak. Akan tetapi, anak-anak sangat sulit bila diminta untuk mengeluarkan dahak. Bila pun ada, jumlah dahak yang dikeluarkan tidak cukup. Jumlah dahak yang cukup untuk dilakukan pemeriksaan basil tahan asam adalah sebesar 3-5 ml, dengan konsistensi kental dan purulen.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Masalah kedua adalah jumlah kuman M. tuberculosis dalam sekret bronkus anak lebih sedikit daripada orang dewasa. Hal itu dikarenakan lokasi primer TB pada anak terletak di kelenjar limfe hilus dan parenkim paru bagian perifer. BTA positif baru dapat dilihat bila minimal jumlah kuman 5000/ml dahak. Selain itu, gejala klinis TB pada anak tidak khas. Hal-hal tersebutlah yang sering membuat kita misdiagnosis atau overdiagnosis. Gejala TB pada anak sangat bervariasi dan tidak saja melibatkan organ pernafasan melainkan banyak organ tubuh lain seperti kulit (skrofuloderma), tulang, otak, mata, usus, dan organ lain. Jangan sampai salah diagnosis atau overdiagnosis! </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Untuk itu dalam makalah ini kami akan membahas bagaimana cara mengetahui anak yang terinfeksi TB dan bagaimana Asuhan Keperawatannya?</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><b>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Rumusan Masalah</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Dari uraian diatas, muncul persoalan pokok : seperti apa itu penyakit TB (Tuberculosis), apa penyebabnya, gejalanya, dan bagaimana dengan TB pada anak? Samakah dengan TB pada Orang dewasa dan bagaimana kita melakukan asuhan keperawatan pada anak dengan penyakit tuberculosis?</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><br />
</div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><b><span style="font-size: 14pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><b><span style="font-size: 14pt; line-height: 150%;">TUBERKULOSIS PADA ANAK</span></b></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><br />
</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -34pt;"><b><span lang="IN">A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Pengertian</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Tuberkulosis adalah penyakit infeksi menular yang disebabkan oleh Mycobacterium tubeculosis yaitu suatu bakteri tahan asam, atau Tuberculossis (TB) adalah penyakit akibat infeksi kuman Mycobacterium tuberculosis sistemik sehingga dapat mengenai hampir semua organ tubuh, dengan lokasi terbanyak di paru yang biasanya merupakan lokasi infeksi primer.</div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -33.6pt;"><b><span lang="IN">B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Insiden</b></div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;">Penyakit tuberkulosis adalah penyakit yang sangat epidemik karena kuman Mikobacterium tuberkulosia telah menginfeksi sepertiga penduduk dunia. Program penaggulangan secara terpadu baru dilakkan pada tahun 1995 melalui strategi DOTS (directly observed treatment shortcourse chemoterapy), meskipun sejak tahun 1993 telah dicanangkan kedaruratan global penyakit tuberkulosis. Kegelisahan global ini didasarkan pada fakta bahwa pada sebagian besar negara di dunia, penyakit tuberkulosis tidak terkendali, hal ini disebabkan banyak penderita yang tidak berhasil disembuhkan, terutama penderita menular (BTA positif). </div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;">Pada tahun 1995, diperkirakan setiap tahun terjadi sekitar sembilan juta penderita dengan kematian tiga juta orang (WHO, 1997). Di negara-negara berkembang kematian karena penyakit ini merupakan 25 % dari seluruh kematian, yang sebenarnya dapat dicegah. Diperkirakan 95 % penyakit tuberkulosis berada di negara berkembang, 75 % adalah kelompok usia produktif (15-50 tahun). Tuberkulosis juga telah menyebabkan kematian lebih banyak terhadap wanita dibandingkan dengan kasus kematian karena kehamilan, persalinan dan nifas. </div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;">Di Indonesia pada tahun yang sama, hasil survey kesehatan rumah tangga (SKRT) menunjukkan bahwa penyakit tuberkulosis merupakan penyebab kematian nomor tiga setelah penyakit jantung dan penyakit infeksi saluran pernapasan pada semua kelompok usia, dan nomor satu dari golongan penyakit infeksi. WHO memperkirakan setiap tahun menjadi 583.000 kasus baru tuberkulosis dengan kematian sekitar 140.000. secara kasar diperkirakan setiap 100.000 penduduk Indonesia terdapat 130 penderita baru tuberkulosis dengan BTA positif. Organisasi Kesehatan Dunia (WHO) melaporkan juga terdapat lebih dari 250.000 anak menderita TB dan 100.000 di antaranya meninggal dunia. Di Indonesia, TB merupakan masalah utama kesehatan masyarakat. Jumlah pasien TB di Indonesia merupakan ke-3 terbanyak di dunia setelah India dan Cina dengan jumlah pasien sekitar 10% dari total jumlah pasien TB didunia. Diperkirakan pada tahun 2004, setiap tahun ada 539.000 kasus baru dan kematian 101.000 orang. Insidensi kasus TB BTA positif sekitar 110 per 100.000 penduduk.</div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -33.6pt;"><b><span lang="IN">C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Etiologi Dan Penularan</b></div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;">Tuberculosis merupakan penyakit infeksi yang disebabkan oleh Mycobacterium tuberculosis dan Micobacterium bovis (sangat jarang disebabkan oleh Micobacterium avium). Mycobacterium tuberculosis ditemukan oleh Robert Koch pada tahun 1882. Basil tuberkulosis dapat hidup dan tetap virulen beberapa minggu dalam keadaan kering, tetapi dalam cairan mati pada suhu 60°C dalam 15-20 menit. Fraksi protein basil tuberculosis menyebabkan nekrosis jaringan sedangkan lemaknya menyebabkan sifat tahan asam dan merupakan faktor penyebab terjadinya fibrosis dan terbentuknya sel epiteloid dan tuberkel. Basil Mycobacterium tuberculosis tidak membentuk toksin (baik endotoksin maupun eksotoksin). </div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;">Penularan Mycobacterium tuberculosis biasanya melalui udara hingga sebagian besar fokus primer tuberculosis terdapat dalam paru. Selain melalui udara penularan dapat peroral misalnya minum susu yang mengandung basil tuberculosis, biasanya Mycobacterium bovis. Dapat juga terjadi dengan kontak langsung misalnya melalui luka atau lecet di kulit. Tuberculosis kongenital sangat jarang dijumpai. Selain Mycobacterium tuberculosis perlu juga dikenal golongan Mycobacterium lain yang dapat menyebabkan kelainan yang menyerupai tuberculosis. Golongan ini disebut Mycobacterium atipic atau disebut juga unclassified Mycobacterium.</div><div align="center" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: center;"><br />
</div><div align="center" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: center;"><br />
</div><div align="center" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: center;"><br />
</div><div align="center" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: center;"><img height="459" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.jpg" width="469" /></div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b>Faktor Resiko</b></div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b>Resiko Infeksi TBC</b></div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;">Anak yang memiliki kontak dengan orang dewasa dengan TBC aktif, daerah endemis, penggunaan obat-obat intravena, kemiskinan serta lingkungan yang tidak sehat. Pajanan terhadap orang dewasa yang infeksius,<br />
Resiko timbulnya transmisi kuman dari orang dewasa ke anak akan lebih tinggi jika pasien dewasa tersebut mempunyai BTA sputum yang positif, terdapat infiltrat luas pada lobus atas atau kavitas produksi sputum banyak dan encer, batuk produktif dan kuat serta terdapat faktor lingkungan yang kurang sehat, terutama sirkulasi udara yang tidak baik. Pasien TBC anak jarang menularkan kuman pada anak lain atau orang dewasa disekitarnya, karena TBC pada anak jarang infeksius, hal ini disebabkan karena kuman TBC sangat jarang ditemukan pada sekret endotracheal, dan jarang terdapat batuk. Walaupun terdapat batuk tetapi jarang menghasilkan sputum. Bahkan jika ada sputum pun, kuman TBC jarang sebab hanya terdapat dalam konsentrasi yang rendah pada sektret endobrokial anak .</div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><br />
</div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><b>Resiko Penyakit TBC</b></div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;">Anak ≤ 5 tahun mempunyai resiko lebih besar mengalami progresi infeksi menjadi sakit TBC, mungkin karena imunitas selulernya belum berkembang sempurna (imatur). Namun, resiko sakit TBC ini akan berkurang secara bertahap seiring pertambahan usia. Pada bayi < 1 tahun yang terinfeksi TBC, 43% nya akan menjadi sakit TBC, sedangkan pada anak usia 1-5 tahun, yang menjadi sakit hanya 24%, pada usia remaja 15% dan pada dewasa 5-10%. Anak < 5 tahun memiliki resiko lebih tinggi mengalami TBC diseminata dengan angka kesakitan dan kematian yang tinggi. Konversi tes tuberkulin dalam 1- 2 tahun terakhir, malnutrisi, keadaan imunokompromis, diabetes melitus, gagal ginjal kronik dan silikosis. Status sosial ekonomi yang rendah, penghasilan yang kurang,kepadatan hunian, pengangguran, dan pendidikan yang rendah2.</div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: -36pt;"><b>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Patofisiologi</b></div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;">Masuknya basil tuberculosis dalam tubuh tidak selalu menimbulkan penyakit. Terjadinya infeksi dipengaruhi oleh virulensi dan banyaknya basil tuberculosis serta daya tahan tubuh manusia. Infeksi primer biasanya terjadi dalam paru. Ghon dan Kudlich (1930) menemukan bahwa 95,93% dari 2.114 kasus, mereka mempunyai fokus primer di dalam paru. Hal ini disebabkan penularan sebagian besar melalui udara dan mungkin juga karena jaringan paru mudah kena infeksi tuberkulosis (susceptible).</div><div style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;"><b>Tabel 1. Lokalisasi Fokus Primer TB</b></div><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; color: magenta; margin-left: 41.4pt;"><tbody>
<tr> <td colspan="4" style="border-color: -moz-use-text-color -moz-use-text-color windowtext; border-style: none none solid; border-width: medium medium 1pt; padding: 0cm 5.4pt; width: 396pt;" valign="top" width="528"><div class="MsoNormal" style="line-height: 150%;">Lokalisasi Fokus Primer pada 2.114 kasus Ghon dan Kudlich ialah : </div></td> </tr>
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</div><br clear="ALL" style="color: magenta;" /> <div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify;">Gambar 1. Patogenesis tuberkulosis</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Bagan di atas dapat dijelaskan sebagai berikut :</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Masuknya kuman tuberkulosis ke dalam tubuh tidak selalu menimbulkan penyakit. Infeksi dipengaruhi oleh virulensi dan banyaknya basil tuberkulosis serta daya tahan tubuh manusia. Segera setelah menghirup basil tuberkulosis hidup di dalam paru-paru, maka terjadi eksudasi dan konsolidasi yang terbatas disebut fokus primer. Basil tuberkulosis akan menyebar, histosit mulai mengangkut organisme tersebut ke kelenjar limfe regional melalui saluran getah bening menuju kelenjar regional sehingga terbentuk kompleks primer dan mengadakan reaksi eksudasi terjadi sekitar 2 sampai 10 minggu (6-8 minggu) pasca infeksi. <br />
</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Pada anak yang mengalami lesi, dalam paru dapat terjadi dimanapun terutama di perifer dekat pleura, tetapi lebih banyakk terjadi di Lapangan bawah paru dibanding dengan lapangan atas. Juga terdapat pembesaran kelenjar regional serta penyembuhannya mengarah ke klasifikasi dan penyebarannya lebih banyak terjadi melalui hematogen. Pada reaksi radang dimana leukosit polimorfonukleat tampak pada alveoli dan memfagosit bakteri namun tidak membunuhnya. Kemudian basil menyebar ke limfe dan sirkulasi. Dalam beberapa minggu limfosit T menjadi sensitif terhadap organisme TBC dan membebaskan limfokim yang merubah makrofag atau mengaktifkan makrofag. Alveoli yang terserang akan mengalami konsolidasi dan timbul gejala pneumonia akut. Pneumonia seluler ini dapat sembuh dengan sendirinya, sehingga tidak ada sisa nekrosis yang tertinggal, atau proses dapat berjalan terus dan bakteri terus difagosit atau berkembang biak dalam sel. Makrofag yang mengadakan infiltrasi menjadi lebih panjang dan sebagian bersatu sehingga membentuk sel tuberkel epiteloid yang dikelilingi oleh limfosit. Nekrosis pada bagian sentral memberikan gambaran yang relatif padat pada tubuh, yang disebut nekrosis kasiosa. Terdapat tiga macam penyebaran secara patogen pada tuberkulosis anak : penyebaran Hematogen tersembunyi yang kemudian mungkin menimbul gejala atau tanpa gejala klinis, penyebaran milier, biasanya terjadi sekaligus dan menimbulkan gejala akut, kadang-kadang kronis, penyeberan hematogen berulang. <br />
</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -33.6pt;"><b>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Manifestasi Klinik </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Gejala klinis TB tergantung faktor pejamu (usia, status imun, kerentanan) dan faktor agen (jumlah, virulensi). Gejala TB pada anak yang umum terjadi adalah demam yang tidak tinggi (subfebris), berkisar 38 derajad Celcius, biasanya timbul sore hari, 2-3 kali seminggu dan belangsung 1-2 minggu dengan atau tanpa batuk dan pilek. Gejala lain adalah penurunan nafsu makan, dan gangguan tumbuh kembang. Batuk kronik yang merupakan gejala tersering pada TB paru dewasa, tidak terlalu mencolok pada anak. Mengapa? Sebab lesi primer TB paru pada anak umumnya terdapat di daerah parenkim yang tidak mempunyai reseptor batuk. Kalaupun terjadi, berarti limfadenitis regional sudah menekan bronkus dimana terdapat reseptor batuk. Batuk kronik pada anak lebih sering dikarenakan oleh asma.<b> </b>Gejala-gejala yang tersebut di atas dikategorikan sebagai gejala nonspesifik. Perlu dicatat bahwa gejala nonspesifik dapat juga ditemukan pada kasus infeksi lain. Maka dari itu, keberadaan infeksi lain perlu dipikirkan agar anak tidak overtreated. Selanjutnya, gejala spesifik tergantung dari organ yang terkena seperti kulit (skrofuloderma), tulang, otak, mata, usus, dan organ lain.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Atau secara singkat tanda dan gejala umum/nonspesifik tuberkulosis pada anak dapat disebutkan sebagai berikut : </div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat badan turun tanpa sebab yang jelas atau tidak naik dalam 1 bulan dengan penanganan gizi </span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anoreksia dengan gagal tumbuh dan berat badan tidak naik secara adekuat (failure to thrive)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Demam lama dan berulang tanpa sebab yang jelas (bukan tifus, malaria, atau infeksi saluran napas akut), dapat disertai keringat malam</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembesaran kelenjar limfe superfisialis yang tidak sakit dan biasanya multipel</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Batuk lama lebih dari 30 hari</span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diare persisten yang tidak sembuh dengan pengobatan diare</span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Gejala spesifik sesuai organ terkena : TB kulit/skrofuloderma; TB tulang dan sendi (gibbus, pincang); TB otak dan saraf/meningitis dengan gejala iritabel, kuduk kaku, muntah, dan kesadaran menurun; TB mata (konjungtivitis fliktenularis, tuberkel koroid), dll. Oleh karena gejala TB pada anak sangat bervariasi dan tidak saja melibatkan organ pernafasan melainkan banyak organ tubuh lain, maka ada yang menyebut TB sebagai the great immitator.<b> </b>Perhatikan bila gerak anak kurang aktif jika dibandingkan dengan anak sebayanya. </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Kelenjar limfe. Kelenjar limfe superfisialis sering dijumpai, kelenjar yang sering terkena adalah kelenjar limfe kolli anterior atau posterior, juga dapat terjadi aksila, inguinal, submandibula dan supra klavikula. Secara klinis kelenjar yang terkena biasanya multipel, unilateral, tidak nyeri tekan, tidak panas pada perabaan dan dapat saling melekat satu sama lain. Perlekatan ini terjadi akibat adanya inflamasi pada kapsul kelenjar limfe. TBC kulit/skrofuloderma. TBC tulang dan sendi : Gejala umum yang sering ditemukan adalah adanya nyeri, bengkak disendi yang terkena dan gangguan atau keterbatasan gerak. Pada bayi dan anak yang sedang tumbuh epifisis tulang merupakan daerah dengan baskularisasi tinggi yang disukai oleh kuman TBC. Tulang punggung (spondilitis) : gibbus, tulang panggul (koksitis) : pincang, pembengkakan di pinggul, tulang lutut: pincang dan/atau bengkak, tulang kaki dan tangan. TBC otak dan saraf: Meningitis TBC, Merupakan penyakit yang berat dengan mortalitas dan kecacatan yang tinggi, terjadi akibat penyebaran langsung kuman TBC ke jaringan selaput saraf (meningens). Dengan gejala iritabel, kaku kuduk, muntah-muntah dan kesadaran menurun. TBC mata: Conjunctivitis phlyctenularis. Tuberkel koroid (hanya terlihat dengan funduskopi) dan Lain-lain.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Jika berdasarkan klasifikasinya, manifestasi TB pada anak adalah sebagai berikut : Ranke membagi tuberkulosis dalam 3 stadium, yaitu : stadium pertama yang merupakan kompleks primer dengan penyebaran limfogen. Stadium ke dua yaitu Pada waktu terjadi penyebaran hematogen dan Stadium ketiga yaitu Tuberkulosis paru menahun (crhonic pulmonary tuberkulosis). Klasifikasi lain dari tuberkulosis adalah: Tuberkulosis primer yang merupakan infeksi pertama dari tuberculosis, tuberkulosis subprimer yang merupakan komplikasi tuberkulosis primer serta Tuberkulosis pascaprimer yang merupakan reinfeksi yang dapat terjadi endogen dan estrogen setelah infeksi primer sembuh. Ada juga yang membagi tuberkulosis menjadi dua stadium, yaitu<sup> </sup>Tuberkolosis primer yang merupakan kompleks primer serta komplikasinya. Dan Tubekolosis pasca primer. Permulaan tuberkulosis primer biasanya sukar diketahui secara klinis karena penyakit secara perlahan-lahan. Kadang-kadang tuberkulosis ditemukan pada anak tanpa keluhan atau gejala. Dengan melakukan uji tuberkulin secara rutin, dapat ditemukan penyakit tuberkulosis pada anak. Gejala tuberkulosis primer juga dapat panas yang naik turun selama 1-2 minggu dengan atau tanpa batuk dan pilek.Gambaran klinis tuberkulosis primer lain ialah panas, batuk, anoreksia dan berat badan yang menurun. Kadang-kadang dijumpai panas yang menyerupai tifus abdominalis atau malaria yang disertai atau tanpa hepatosplenomegali. Oleh karena itu bila dijumpai panas seperti tifus abdominalis pada bayi atau anak kecil,harus dipikirkan juga kemungkinan tuberkulosis sebagai penyebab panas tersebut. Tuberkulosis dapat juga menunjukkan gejala seperti brokopneumonia, sehingga pada anak dengan gejala bronkopneumonia yang tidak menunjukkan perbaikan dengan pengobatan brokopneumonia yang adekuat harus dipikirkan kemungkinan tuberkulosis. Konjungtivitis fliktenularis dapat juga dijumpai pada anak dengan tuberkulkosis ,terutama tuberkulosis tonsil, adenoid dan telinga tengah. Flikten pada mata diduga sebagai gejala hipersensivitas dan dalam flikten tidak terdapat basil tuberkulosis. Selama tuberkulosis atau fokus tuberkulosis masih ada, flikten sering tetap hilang timbul. Flikten sering disertai infeksi sekunder biasanya oleh Staphylococus hemolyticus. Hal lain yang juga dapat menyebabkan timbulnya flikten ialah benda asing, trakoma dan askariasis. Eritema nodusum sangat jarang dijumpai di Indonesia, tetapi bila terdapat pada kulit menunjukkan bahwa penyakit masih aktif. Gambaran klinis lainnya sesuai dengan organ yang terkana misalnya paru, selaput otak, hepar, tulang dan sendi, ginjal dan lain-lain. </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -33.6pt;"><b>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Komplikasi</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 53.45pt; text-align: justify; text-indent: 18.55pt;">Komplikasi Yang dapat terjadi adalah sebagai berikut :</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Meningitis</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Spondilitis </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Pleuritis</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Bronkopneumoni</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Atelektasis </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Hemoptisis berat (perdarahan dari saluran nafas bawah) yang dapat mengakibatkan kematian karena syok hipovolemik atau tersumbatnya jalan nafas. <br />
Kolaps dari lobus akibat retraksi bronkial. Bronkiectasis (pelebaran bronkus setempat) dan fibrosis (pembentukan jaringan ikat pada proses pemulihan atau reaktif) pada paru. Pneumotorak (adanya udara didalam rongga pleura) spontan: kolaps spontan karena kerusakan jaringan paru. Penyebaran infeksi ke organ lain seperti otak, tulang, persendian, ginjal dan sebagainya. Insufisiensi Kardio Pulmoner (Cardio Pulmonary Insufficiency).</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -33.6pt;"><b>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Pemeriksaan Diagnostik</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Permulaan tuberkulosis sukar diketahui karena gejalanya tidak jelas dan tidak khas,tetapi kalau terdapat panas yang naik turun dan lama dengan atau tanpa batuk dan pilek, anoreksia, penurunan berat badan dan anak lesu, harus dipikirkan kemungkinan tuberkulosis. Petunjuk lain umtuk diagnosis tuberkulosis ialah adanya kontak dengan penderita tuberkulosis orang dewasa. Diagnosis tuberkulosis paru berdasarkan gambaran klinis, uji tuberkulin positif dan kelainan radiologis paru. Basil tuberkulosis tidak selalu dapat ditemukan pada anak<sup> </sup></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Uji Tuberkulin </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;">Pemeriksaan ini merupakan alat diagnosis yang penting dalam menegakkan diagnosis tuberkulosis.uji tuberkulin lebih penting lagi artinya pada anak kecil bila diketahui adanya komversi dari negatif (recent tuberculin converter).pada anak dibawah umur lima tahun dengan uji tuberkulin positif,proses tuberkulosis biasanya masih aktifmeskipun tidak menunjukkan kelainan klinis dan radiologis, demikian pula halnya jika terdapat konfersi uji tuberkulin. Uji tuberkulin dilakukan berdasarkan timbulnya hipersensitivitas terhadap tuberkulo protein karena adanya infeksi<sup> </sup></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;">Ada beberapa cara melakukan uji tuberkulin yaitu cara moro dengan salep, dengan goresan disebut patch test cara von pirquet, cara mantoux dengan penyuntikan intrakutan dan “multiple puncture method “ dengan empat-enam jarum berdasarkan cara Heaf dan tine. Sampai sekarang cara mantoux masih dianggap sebagai cara yang paling dapat dipertanggungjawabkan karena jumlah tuberkulin yang dimasukkan dapat diketahui banyaknya. Reaksi lokal yang terdapat pada mantoux terdiri atas: Eritema karena vasodilatasi primer, Edema karena reaksi antara antigen yang disuntikkan dengan antibody dan indurasi yang dibentuk oleh sel mononukleus<sup> </sup></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;">Pembacaan uji tuberkulin dilakukan 48-72 jam setelah penyuntikan dan diukur diameter melintang dari indurasi yang terjadi. Tuberkulin yang biasanya dipakai ialah Old Tuberculin (OT) dan purified protein Derivative tuberculin (PPD). Pengeceran OT dan PPD yang biasanya digunakan ialah : Dosis baku tuberkulin uji mantoux ialah 0,1 ml PPD-RT 23 2TU,PPD-S 5 TU atau OT ½ .000 yang disuntikkan intrakutan. Indurasi dengan diameter 5 mm ke atas dianggap positif dengan catatan 0-4 mm negatif, 5-9 mm masih meragukan dan 10 mm keatas jelas positif. Kalau uji tuberkulin dengan PPD-RT 23 2TU,PPD-S 5TU atau dengan OT ½.000 negatif , maka pemeriksaan harus diulang dengan PPD-RT 23 100 TU atau OT 1/100 untuk memastikan bahwa uji tuberkulin itu negatif. Juga kalau dengan PPD-RT 23 2TU,PPD-S 5TU atau OT ½.000 negatif tetapi masih dicurigai akan adanya tuberkulosis aktif, misalnya diketahui terdapat kontak dengan penderita tuberkulosis aktif, keadaan umum yang jelek dan kemungkinan adanya anergi, maka pemeriksaan diulang dengan PPD-RT23 100 TU atau OT 1/100<sup> </sup></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; margin-left: 72pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tabel 2. Pengeceran Tuberkulin</span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; color: magenta; margin-left: 59.4pt;"><tbody>
<tr> <td rowspan="2" style="border: 1pt solid black; padding: 0cm 5.4pt; width: 54.3pt;" width="72"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Kekuatan</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">(“strength”)</span></b></div></td> <td colspan="2" style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 125.55pt;" width="167"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Tuberkulin PPD-S</span></b></div></td> <td rowspan="2" style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 68pt;" width="91"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Tuberkulin</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">PPD-RT23</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">TU</span></b></div></td> <td colspan="2" style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 133.45pt;" width="178"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">“Old Tuberkolin”</span></b></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 64.75pt;" width="86"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Mg per</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">dosis</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 60.8pt;" width="81"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">TU</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 65.15pt;" width="87"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">Mg perdosis</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 68.3pt;" width="91"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif";">pengeceran</span></b></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 54.3pt;" valign="top" width="72"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Pertama</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">(“fisrt”)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">“intermediate”</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Kedua</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">(“second”)</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 64.75pt;" width="86"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Times New Roman","serif";">0,00002</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">0,0001</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">-</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">0,005</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 60.8pt;" width="81"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">1</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">2</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">10</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">250</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 68pt;" width="91"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">-</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">2</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">5</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">100</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 65.15pt;" width="87"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">0,01</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">-</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">0,1</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif";">100</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 68.3pt;" width="91"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><img height="36" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image006.gif" width="44" /></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><img height="36" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image008.gif" width="35" /></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><img height="36" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image010.gif" width="35" /></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><img height="36" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image012.gif" width="24" /></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
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</tbody></table><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di Indonesia uji mantoux dengan OT 1/100 (PPD-RT23 2TU atau PPD-S 5TU) negatif. Sebaiknya uji tuberkulin dikerjakan secara rutin pada setiap anak dan kalau negatif diulang 6-12 bulan untuk menemukan tuberkulosis sedini mungkin. Penyuntikan BCG menyebabkan konversi uji tuberkulin sehingga dapat mengacaukan penilaian uji tubekulin untuk diagnosis tuberkulosis. Dinyatakan bahwa bila anak yang telah mendapat BCG, kemudian hasil uji tuberkulin dengan PPD –RT23 2TU, PPD-S 5TU atau OT ½.000 menimbulkan indyrasi lebih dari 15 mm, maka harus dicurugai akan adanya super infeksi tuberkulosis. Jika BCG diberikan pada masa neonatus, maka hanya setalah 1 tahun hanya 10 % yang mempunyai reaksi dengan indurasi 5 mm atau lebih terhadap PPD-RT23 2TU atau PPD-S 5TU dan tidak ada yang bereaksi dengan diameter indurasi 10 mm ke atas<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Uji tuberkulin akan menjadi negatif untuk sementara pada penderita tuberkulosis (anergi) dengan : Malnutrisi energi protein, Tuberkulosis berat, Morbili,varisela, Pertusis,difteria,tifus abdominalis, Pemberian kortikosteroid yang lama, Vaksin virus misalnya poliomyelitis serta Penyakit ganas,misalnya penyakit hodgkin<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Radiologis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada anak dengan uji tuberkulin positif dilakukan pemeriksaan radiologis. Secara rutin dilakukan fotorontgen paru dan atas indikasi juga dibuat fotorontgen alat tubuh lain,misalnya foto tulang punggung pada spondilitis.<b> </b>Gambaran radiologis paru yang biasanya dijumpai pada tuberkulosis paru ialah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kompleks primer dengan atau tanpa perkapuran </span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pembesaran kelenjar paratrakeal </span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebaran milier </span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Atelektasis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pleuritis dengan efusi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan radiologis paru saja tidak dapat digunakan untuk membuat diagnosis tuberkulosis,tetapi harus disertai data klinis lainnya<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Bakteriologis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penemuan basil tuberkulosis memastikan diagnosis tuberkulosis, tetapi tidak ditemukannya basil tuberkulosis bukan berarti tidak menderita tuberkulosis.<b> </b>Bahan-bahan yang digunakan untuk pemeriksaan bakteriologis ialah:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bilasan lambung</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sekret bronkus</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sputum pada anak besar </span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cairan pleura</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Likuor serebrospinalis </span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cairan asites</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bahan-bahan lainnya</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di Negeri yang telah telah maju dengan sarana laboratorium yang baik, basil tuberkulosis dapat ditemukan sebesar 50-90% dari anak dengan tuberkulosis. Pada umumnya hanya dapat ditemukan 25-30% saja. Di Jakarta pada tahun 1956-1960 pemeriksaan bilasan lambung pada 204 anak dengan meningitis tuberkulosa menghasilkan basil tuberkulosis positif pada 27 (13%) anak dan ada pemeriksaan likuor serebrospinalisnya hanya ditemukan 18,5% (38 anak)<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Patologi Anatomi</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan patologi anatomi tidak dilakukan secara rutin. Biasanya diperiksa kelenjar getah bening, hepar, pleura, peritoneum, kulit dan lain-lain. Pada pemeriksaan biasanya ditemukan tuberkulosis dan basil tahan asam.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Uji Laboratorium</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">LED meninggi, sering tinggi sekali. Mungkin liositosis, monositosis, anemia, leukositosis ringan, bila ditemui hasil demikian (bila tidak ada faktor lain) akan menyokong diagnosis. Gambaran darah normal tidak menyingkirkan TBC. Gambaran darah tepi dan laju endap darah hanya mempunyai korelasi dengan aktivitas penyakit. Pemeriksaan cairan spinal dilakukan atas indikasi kecurigaan meningitis dan pada setiap TBC milier.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Uji BCG</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di Indonesia BCG diberikan secara langsung tanpa didahului uji tuberkulin (BCG langsung). Bila pada anak yang mendapat BCG langsung terdapat reaksi lokal yang besar dalam waktu kurang dari 7 hari setelah penyuntikan, maka harus dicurigai adanya tuberkulosis dan diperiksa lebih lanjut kearah tuberkulosis. Pada anak dengan tuberkulosis, BCG akan menimbulkan reaksi lokal yang lebih cepat dan besar. Karena itu reaksi BCG ini dapat dipakai sebagai alat diagnostik<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sering terdapat kesukaran untuk diagnosis tuberkulosis yang dini pada anak dengan malnutrisi karena adanya anergi terhadap tuberkulin.Udani (1970) menyatakan bahwa uji BCG tidak terdapat anergi.<b> </b>Akhir-akhir ini sedang diselidiki pemeriksaan serologis untuk menunjang diagnosis tuberkulosis<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebaran hematogen tuberkulosis (hematogenous tuberculosis) terdapat 3 macam penyebaran hematogen pada tuberkulosis anak,yaitu:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebaran hematogen tersembunyi (occult hematogenic spread) yang mungkin menimbulkan gejala atau mungkin tanpa gejala klinis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebaran hematogen umum (generalized hematogenic spread, penyebaran milier), biasanya terjadi sekaligus dan menimbulkan gejala akut, kadang-kadang menjadi kronis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebaran hematogen berulang-ulang (protracted or repeated hematogenic spread).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebaran hematogen tersembunyi ( occult hematogenic spread). Penyebaran basil tuberkulosis dalam jumlah yang sedikit selama stadium dini tuberkulosis dan disebut occult hematogenic spread. Penyebaran ini selalu terjadi pada tuberkulosis primer meskipun tidak selalu tersebar luas, biasanya terjadi pada masa inkubasi<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Basil tuberkulosis dapat mencapai semua alat tubuh terutama apeks paru, limpa dan kelenjar getah bening superfisial. Pada keadaan ini dapat terjadi pembesaran limpa dan kelenjar getah bening superfisial, kadang-kadang hepar juga teraba. Fokus pada apeks jarang terlihat pada fotorontgen paru, kecuali kalau telah terjadi perkapuran yang disebut fokus Simun yang mungkin akan menjadi tuberkulosis pasca-primer dimasa yang akan datang. Penyebaran hematogen umum (generalized hematogenis spread). <b>Tuberkulosis Milier Akut</b>. tuberkel-tuberkel yang terjadi akibat penyebaran umum ini biasanya mempunyai ukuran sama, meskipun tidak selalu sebesar miliarius (kurang dari 2 mm), sehingga disebut tuberkulosis milier. Komplikasi ini biasanya terjadi pada masa bayi dan anak kecil dan terjadi dalam waktu 6 bulan, terutama dalam 3 bulan setelah terbentuknya kompleks primer. Dapat terjadi pembesaran hepar, limpa dan kelenjar getah bening superfisial. Tuberkel dapat dijumpai dikoroid. Uji tuberkulin biasanya positif, menurut Lincoln pada 10% kasus tuberkulosis milier, uji tuberkulin negatif<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada fotorontgen paru akan tampak gambaran milier biakan basil tuberkulosis dari darah dan sum-sum tulang memastikan diagnosis tuberkulosis milier secara cepat. Pemeriksaan likuor serebrospinalis harus dikerjakan meskipun belum ada gejala meningitis, yaitu untuk menemukan meningitis secara dini. Gambaran milier biasanya hilang sama sekali dan pada penyembuhan jarang terjadi klasifikasi. Harus diingat bahwa penyebaran milier terjadi keseluruh tubuh dengan kemungkinan basil tuberkulosis menetap dialat-alat tubuh terssebut dan suatu ketika fokus-fokus tersebat dapat aktif lagi. Oleh karenanya setelah selesai pengobatan masih harus dilakukan pngawasan sampai bertahun-tahun<sup> </sup></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tuberkulosis Milier Kronik. </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jarang terjadi pada anak, biasanya didahului oleh tuberkulosis milier akut. Penyebaran hemotogen berulang-ulang (protracted hematogenic spread).<b> </b>Tiap fokus tuberkulosis dapat membesar dan menembus pembuluh darah sehingga terjadi penyebaran hematogen yang dapat terjadi sewaktu-waktu dan berulang-ulang. Penyebaran ini dapat menyebabkan gejala akut atau dapat juga memperpanjnag masa penyakitnya,karena adanya penyebaran hematogen terus menerus. Gejala pertama penyebaran ialah demam tinggi yang berlangsung lama atau dapat menjadi demam remiten, berat badan turun dengan cepat, hepar dan limpa membesar, kelenjar getah bening superfisial juga membesar dan kadang-kadang mengganggu aliran limfe. Dapat terjadi pembengkakan persendian yang dapat menghilang sendiri tanpa pengobatan. Gejala ini dapat disebabkan karena bahan-bahan toksik basil tuberkulosis yang beredar di dalam aliran darah.<b> Prognosis</b> biasanya buruk, terutama bila tidak segera mendapat pengobatan. </span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada anak, kesulitan menegakkan diagnosis pasti disebabkan oleh 2 hal, yaitu: pertama Sedikitnya jumlah kuman. Jumlah kuman TBC di sekret bronkus pasien anak lebih sedikit daripada dewasa karena lokasi kerusakan jaringan TBC paru primer terletak dikelenjar linfe hilus dan parenkim paru bagian perifer. Tingkat kerusakan parenkim paru tidak seberat pada dewasa. Kedua, Sulitnya pengambilan spesimen (sputum) Pada anak , walaupun batuknya berdahak biasanya dahak akan ditelan sehingga diperlukan bilasan lambung yang diambil melalui nasogastrik tube dan harus dilakukan oleh petugas yang berpengalaman. Karena berbagai alasan diatas, sehingga sebagian besar diagnosis TBC anak didasarkan atas gambaran klinis, gambaran foto rontgen dada dan uji tuberkulin.</span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><b>Tabel 3. Petunjuk Who Untuk Diagnosis Tuberkulosis Anak</b></div><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; color: magenta; margin-left: 59.4pt;"><tbody>
<tr> <td style="border-color: black -moz-use-text-color; border-style: solid none; border-width: 1pt medium; padding: 0cm 5.4pt; width: 369.6pt;" valign="top" width="493"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.1pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dicurigai tuberculosis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak sakit dengan riwayat kontak penderita tuberkulosis dengan diagnosis pasti (BTA positif)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak dengan :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keadaan klinik tidak membaik setelah menderita campak atau batuk rejan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat badan menurun, batuk dan mengi yang tidak membaik dengan pengobatan antibiotik untuk penyakit pernapasan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembesaran kelenjar superfisialis yang tidak sakit</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.1pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mungkin tuberkulosis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Uji tuberkulin positif (10 mm/lebih)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Foto Rontgen paru sugestif tuberkulosis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan histologis biopsi sugestif tuberkulosis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 31.5pt; text-align: justify; text-indent: -13.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Respon yang baik pada pengobatan dengan OAT</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.1pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasti tuberkulosis (confirmed TB)</span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ditemukan basil tuberculosis pada pemeriksaan langsung atau biakan. Identifikasi Mycobacterium tuberculosis pada karakteristik biakan</span></div></td> <td style="border-color: black -moz-use-text-color; border-style: solid none; border-width: 1pt medium; padding: 0cm 5.4pt; width: 11.7pt;" valign="top" width="16"><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Petunjuk diagnosis TB. </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -33.6pt;"><b><span lang="IN">H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Penatalaksanaan Terapeutik</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><b>Kemoterapi </b>: Pemberian terapi pada tuberculosis didasarkan pada 3 karakteristik basil, yaitu basil yang berkembang cepat ditempat yang kaya akan oksigen, basil yang hidup di tempat yang kurang oksigen berkembang lambat dan dorman hingga beberapa tahun, dan basil yang mengalami mutasi sehingga resisten terhadap obat. Isonized (INH) bekerja sebagai bakterisidal terhadap basil yang tumbuh aktif, diberikan selama 12-18 bulan, dosis 10-20 mg/kgBB/hari melalui oral. Selanjutnya kombinasi antara INH dan pyrazinamid (PZA) diberikan selama 6 bulan. Selama 2 bulan pertama obat diberikan setiap hari, selanjutnya obat diberikan dua kali dalam 1 minggu. Pada TB berat dan ekstrapulmonal biasanya pengobatan dimulai dengan kombinasi 4-5 obat selama 2 bulan (ditambah EMB dan streptomisin), dilanjutkan dengan INH dan RIF selama 4-10 bulan sesuai perkembangan klinis.<b> </b>Pada meningitis TB, perikarditis, TB milier, dan efusi pleura diberikan kortikosteroid yaitu prednison 1-2 mg/kgBB/hari selama 2 minggu, diturunkan perlahan (tapering off) sampai 2-6 minggu bersamaan dengan pemberian obat anti tuberkulosis. Obat tambahan antara lain streptomycin (diberikan intramuscular) dan ethambutol.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Selain itu juga, kita jangan melupakan terapi <b>pemberian nutrisi yang adekuat</b>, untuk menjaga daya tahan tubuh klien agar tidak terjadi penyebaran infeksi ke organ tubuh yang lainnya. Ada juga <b>terapi pembedahan</b>. Terapi ini dilakukan jika kemoterapi tidak berhasil. Dilakukan dengan mengangkat jaringan paru yang rusak, tindakan ortopedi untuk memperbaiki kelainan tulang, bronkoskopi untuk mengangkat polip granulornatosa tuberkulosis untuk jaringan paru yang rusak. Pencegahan adalah dengan menghindari kontak dengan orang yang terinfeksi basil tuberculosis, mempertahankan status kesehatan dengan intake nutrisi yang adekuat, meminum susu yang sudah dilakukan pasteurisasi, isolasi jika pada analisa sputum terdapat bakteri hingga dilakukan kemoterapi, pemberian imunisasi BCG untuk meningkatkan daya tahan tubuh terhadap infeksi oleh basil tuberculosis virulen.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><b>Non Medikamenosa</b>. Pendekatan DOTS Hal yang paling penting pada tatalaksana TBC adalah keteraturan minum obat. Pasien TBC biasanya telah menunjukkan perbaikan beberapa minggu setelah pengobatan sehingga merasa sembuh dan tidak melanjutkan pengobatan. Lingkungan sosial dan pengertian yang kurang mengenai TBC dari pasien serta keluarganya tidak menunjang keteraturan pasien untuk minum obat. Kepatuhan pasien dikatakan baik jika pasien meminum obat sesuai dengan dosis yang ditentukan dalam panduan pengobatan. Kepatuhan pasien ini menjamin keberhasilan pengobatan dan mencegah resistensi. Salah satu upaya untuk meningkatkan kepatuhan pasien adalah dengan melakukan pengawasan langsung terhadap pengobatan.<br />
DOTS ( Directly Observed Treatment Shortcourse) adalah strategi yang telah direkomendasi oleh WHO dalam pelaksanaan program penanggulangan TBC. Strategi ini dilaksanakan di Indonesia sejak tahun 1995. Penanggulangan dengan strategi DOTS dapat memberikan angka kesembuhan yang tinggi.<br />
Sesuai dengan rekomendasi WHO, strategi DOTS terdiri atas 5 komponen, yaitu : Komitmen politis dari para pengambil keputusan, termasuk dukungan dana. Diagnosis TBC dengan pemeriksaan dahak secara mikroskopis, Pengobatan dengan panduan Obat Anti TBC (OAT) jangka pendek dengan pengawasan langsung oleh pengawas menelan obat, Kesinambungan penyedian OAT jangka pendek dengan matu terjamin, Pencatatan dan pelaporan secara baku untuk memudahkan pemantauan dan evaluasi program penanggulangan TBC.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Orang yang dapat menjadi pengawas minum obat adalah : Petugas kesehatan, Keluarga pasien, Kader, Pasien yang sudah sembuh, Tokoh masyarakat, Guru. Tugas pengawas minum obat adalah : Mengawasi pasien agar minum obat secara teratur sampai selesai pengobatan, Memberi dorongan kepada pasien agar mau berobat teratur, Mengingatkan kepada pasien untuk periksa dahak ulang (pasien dewasa) dan Memberi penyuluhan kepada anggota keluarga pasien TBC yang mempunyai gejala-gejala tersangka TBC untuk segera memeriksakan diri ke unit pelayanan kesehatan. Pada anak kuman M. TBC sulit ditemukan, baik pada biakan, lebih-lebih pada pemeriksaan mikroskopis langsung. Oleh karena itu pada anak diagnosis tidak dapat dibuat berdasarkan pemeriksaan mikroskopis yang dianjurkan dalam strategi DOTS. Maka diperlukan strategi diagnostik lain yaitu dengan menggunakan sistem skoring.<sup>(7)</sup></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><b>Kemoprofilaksis. </b>Kemoprofilaksis primer diberikan pada anak yang belum terinfeksi (uji Tuberculin negatif), tetapi kontak dengan penderita TB aktif, obat yang digunakan adalah INH 5-10 mg/kgBB/hari selama 2-3 bulan. Kemoprofilaksis sekunder diberikan pada anak dengan uji tuberculin positif, tanpa gejala klinis, dan foto paru normal, tetapi memiliki faktor menjadi TB aktif. Golongan ini adalah balita, anak yang mendapat pengobatan kortikosteroid atau imunosupresan lain, penderita penyakit keganassan, terinfeksi virus (HIV, morbili), gizi buruk, masa akil balik, atau infeksi baru TB, konfersi uji tuberculin kurang dari 12 bulan. Obat yang digunakan adalah INH 5-10 mg/kgBB/hari selama 6-12 bulan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -33.6pt;"><b><span lang="IN">I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Konsep Asuhan Keperawatan</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18.55pt;"><b>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Pengkajian</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Identitas Data Umum (</b>selain identitas klien, juga identitas orangtua; asal kota dan daerah, jumlah keluarga)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Keluhan Utama (</b>penyebab klien sampai dibawa ke rumah sakit)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Riwayat kehamilan dan kelahiran</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="IN">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Prenatal<span lang="IN"> : (</span>kurang asupan nutrisi , terserang penyakit infeksi selama hamil<span lang="IN">)</span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="IN">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Intranatal : Bayi terlalu lama di jalan lahir , terjepit jalan lahir, bayi menderita caput sesadonium, bayi menderita cepal hematom</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="IN">3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Post Natal : kurang asupan nutrisi , bayi menderita penyakit infeksi , asfiksia ikterus</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Riwayat Masa Lampau</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Penyakit <span lang="IN">yang pernah diderita</span> (tanyakan, apakah klien pernah sakit batuk yang lama dan benjolan bisul pada leher serta tempat kelenjar yang lainnya dan sudah diberi pengobatan antibiotik tidak sembuh-sembuh? Tanyakan, apakah pernah berobat tapi tidak sembuh? Apakah pernah berobat tapi tidak teratur?)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pernah dirawat dirumah sakit </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Obat-obat yang digunakan/riwayat Pengobatan</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Riwayat kontak dengan penderita TBC</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Alergi</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Daya tahan yang menurun.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">7)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Imunisasi/Vaksinasi : BCG</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Riwayat Penyakit Sekarang (</b>Tanda dan gejala klinis TB serta terdapat benjolan/bisul pada tempat-tempat kelenjar seperti: leher, inguinal, axilla dan sub mandibula)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Riwayat Keluarga </b>(adakah yang menderita TB atau Penyakit Infeksi lainnya, Biasanya keluarga ada yang mempunyai penyakit yang sama)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Riwayat Kesehatan Lingkungan dan sosial ekonomi</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Lingkungan tempat tinggal (Lingkungan kurang sehat (polusi, limbah), pemukiman yang padat, ventilasi rumah yang kurang, jumlah anggota keluarga yang banyak), pola sosialisasi anak</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kondisi rumah </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Merasa dikucilkan</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Aspek psikososial (Tidak dapat berkomunikasi dengan bebas, menarik diri)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Biasanya pada keluarga yang kurang mampu</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Masalah berhubungan dengan kondisi ekonomi, untuk sembuh perlu waktu yang lama dan biaya yang banyak</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;">7)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tidak bersemangat dan putus harapan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Riwayat psikososial spiritual (</b>Yang mengasuh<b>, </b>Hubungan dengan anggota keluarga<b>, </b>Hubungan dengan teman sebayanya<b>, </b>Pembawaan secara umum, Pelaksanaan spiritual)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Pola fungsi kesehatan</b>. </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: 36pt;">Pola persepsi sehat dan penatalaksanaan kesehatan. Keadaan umum: alergi, kebiasaan, imunisasi. Pola nutrisi – metabolik. Anoreksia, mual, tidak enak diperut, BB turun, turgor kulit jelek, kulit kering dan kehilangan lemak sub kutan, sulit dan sakit menelan, turgor kulit jelek. Pola eliminasi. Perubahan karakteristik feses dan urine, nyeri tekan pada kuadran kanan atas dan hepatomegali, nyeri tekan pada kuadran kiri atas dan splenomegali. Pola aktifitas-latihan Sesak nafas, fatique, tachicardia, aktifitas berat timbul sesak nafas (nafas pendek). Pola tidur dan istirahat Iritable, sulit tidur, berkeringat pada malam hari.<b> </b>Pola kognitif perseptual. Kadang terdapat nyeri tekan pada nodul limfa, nyeri tulang umum, takut, masalah finansial, umumnya dari keluarga tidak mampu. Pola persepsi diri. Anak tidak percaya diri, pasif, kadang pemarah. Pola peran hubungan Anak menjadi ketergantungan terhadap orang lain (ibu/ayah)/tidak mandiri. Pola seksualitas/reproduktif. Anak biasanya dekat dengan ibu daripada ayah. Pola koping toleransi stres, Menarik diri, pasif.<sup>(7)</sup></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>j.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Pemeriksaan Fisik</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: 36pt;">Demam: sub fibril, fibril (40-41°C) hilang timbul. Batuk: terjadi karena adanya iritasi pada bronkus; batuk ini membuang/ mengeluarkan produksi radang, dimulai dari batuk kering sampai batuk purulen (menghasilkan sputum). Sesak nafas: terjadi bila sudah lanjut, dimana infiltrasi radang sampai setengah paru. Nyeri dada: ini jarang ditemukan, nyeri timbul bila infiltrasi radang sampai ke pleura. Malaise: ditemukan berupa anoreksia, berat badan menurun, sakit kepala, nyeri otot dan kering diwaktu malam hari. Pada tahap dini sulit diketahui. Ronchi basah, kasar dan nyaring. Hipersonor/timpani bila terdapat kavitas yang cukup dan pada auskultasi memberi suara limforik. Atropi dan retraksi interkostal pada keadaan lanjut dan fibrosis. Bila mengenai pleura terjadi efusi pleura (perkusi memberikan suara pekak).<b> </b>Pembesaran kelenjar biasanya multipel. Benjolan/pembesaran kelenjar pada leher (servikal), axilla, inguinal dan sub mandibula. Kadang terjadi abses.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>k.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Pemeriksaan Diagnostik Dan Pengobatan</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><b>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Uji tuberkulin = uji tuberkulin (+).<span style="font-family: Symbol;">®</span> hipersensitifitas tipe lambat <span style="font-family: Symbol;">®</span> imunitas seluler <span style="font-family: Symbol;">®</span>Infeksi TB </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><b>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Foto rontgent Rutin : foto pada rongga paru.<b> </b>Atas indikasi: tulang, sendi, abdomen.<b> </b>Rontgent paru tidak selalu khas.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><b>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Pemeriksaan mikrobiologis (Bakteriologis Memastikan TB. Hasil normal: tidak menyingkirkan diagnosa TB. Hasil (+) : 10-62% dengan cara lama. Cara : cara lama radio metrik (Bactec); PCK.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><b>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Pemeriksaan darah tepi (Tidak khas. LED dapat meninggi)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><b>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Pemeriksaan patologik anatomik. Kelenjar, hepar, pleura; atas indikasi. Sumber infeksiAdanya kontak dengan penderita TB menambah kriteria diagnosa.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><b>6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Lain-lain (Uji faal paru, Bronkoskopi, Bronkografi, Serologim dll)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 71.45pt; text-align: justify; text-indent: -18pt;"><b>l.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Pengkajian TUMBANG menggunakan KMS,KKA, dan DDST </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><b>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Pertumbuhan </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><b>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Kaji BBL,BB saat kunjungan</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><b>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><span lang="IN">BB normal </span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><b>c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>BB normal, mis : ( 6-12 tahun ) umur<span style="position: relative; top: 14pt;"><img height="45" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image014.gif" width="87" /></span> </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><b>d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>kaji berat badan lahir dan berat badan saat kunjungan TB = 64 x 77R = usia dalam tahun </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;"><b>e)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>LL dan luka saat lahir dan saat kunjungan </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 89.45pt; text-align: justify; text-indent: -18pt;"><b>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Perkembangan </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>lahir kurang 3 bulan = belajar mengangkat kepala, mengikuti objek dengan mata, mengoceh, </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>usia 3-6 bulan mengangkat kepala 90 derajat, belajar meraih benda, tertawa, dan mengais meringis</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>usia 6-9 bulan = duduk tanpa di Bantu, tengkuarap, berbalik sendiri, merangkak, meraih benda, memindahkan benda dari tangan satu ke tangan yang lain dan mengeluarkan kata-kata tanpa arti.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>usia 9-12 bulan = dapat berdiri sendiri menurunkan sesuatu mengeluarkan kat-kata, mengerti ajakan sederhana, dan larangan berpartisipasi dalam permainan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">e)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>usia 12-18 bulan = mengeksplorasi rumah dan sekelilingnya menyusun 2-3 kata dapat mengatakan 3-10 kata , rasa cemburu, bersaing</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">f)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>usia 18-24 bulan = naik–turun tangga, menyusun 6 kata menunjuk kata dan hidung, belajar makan sendiri, menggambar garis, memperlihatkan minat pada anak lain dan bermain dengan mereka.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">g)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>usia 2-3 tahun = belajar melompat, memanjat buat jembatan dengan 3 kotak, menyusun kalimat dan lain-lain.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">h)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>usia 3-4 tahun = belajar sendiri berpakaian, menggambar berbicara dengan baik, menyebut warna, dan menyayangi saudara.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -18pt;">i)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>usia 4-5 tahun = melompat, menari, menggambar orang, dan menghitung.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 53.45pt; text-align: justify; text-indent: -18pt;"><b>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Diagnosa Keperawatan</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 17.45pt; text-align: justify; text-indent: 36pt;">Diagnosa yang dapat muncul yaitu :</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Gangguan Pertukaran gas berhubungan dengan proses infeksi<sup> </sup></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Defisit pengetahuan tentang proses infeksi<sup> </sup></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Resiko penyebaran infeksi berhubungan dengan : Daya tahan tubuh menurun, malnutrisi, proses inflamasi, Kurang pengetahuan tentang infeksi kuman.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Ketidakpatuhan berhubungan dengan pengobatan dalam jangka waktu yang lama.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Nutrisi kurang dari kebutuhan tubuh berhubungan dengan : Batuk yang sering, adanya produksi sputum, Anoreksia.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Risiko gangguan dalam menjalankan peran sebagai orang tua berhubungan dengan isolasi pasien<sup> </sup></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 53.45pt; text-align: justify; text-indent: -18pt;"><b>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Rencana Tindakan Keperawatan</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 17.45pt; text-align: justify; text-indent: 36pt;"><b>Dx.1</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 17.45pt; text-align: justify; text-indent: 36pt;"><b>KH : Anak akan mengalami pengurangan batuk dan dipsnue</b> </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 17.45pt; text-align: justify; text-indent: 36pt;"><b><u>Rencana tindakan : </u></b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Berikan oksigen humidifier bagi anak dengan dispnue</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 99pt; text-align: justify; text-indent: -27pt;">R : dispnea masih dapat terjadi, hingga pemberian obat kemoterapi dimulai untuk mendapatkan efeknya, O<sub>2</sub> humidifier mengurangi dipsnue dan meningkatkan oksigenasi.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Tinggikan bagian kepala tempat tidur</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;">R : Peninggian kepala menyebabkan otot diafragma mengembang</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Berikan obat batuk ekspektoran sesuai kebutuhan</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;">R : ekspektoran membantu mengeluarkan mukus</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 18pt;"><b>Dx.2</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -36pt;"><b>KH : Keluarga akan mengekspresikan pemahamannya tentang proses penyakit dan pengobatan </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: 16.9pt;"><b><u>Rencana tindakan : </u></b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Ajarkan Orang Tua dan anak (jika tepat) tentang penularan dan pengobatan TB</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 93.6pt; text-align: justify; text-indent: -21.6pt;">R : pemahaman bagaimana penularan TB dan penangannya membantu mengurangi kecemasan dan peningkatan kepatuhan terhadap pengobatan, prosedur isolasi, dan pengobatan yang diberikan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Ajarkan Orang Tua dan anak (jika tepat) tentang bagaimana memberikan pengobatan, berapa lama terapi pengobatan harus dijalani, dan apa yang terjadi bila anak tidak menjalani tuntas pengobatannya.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 99pt; text-align: justify; text-indent: -27pt;">R : pemahaman bagaimana memberikan pengobatan dan risiko bila pengobatan diberhentikan di awal akan menigkatkan kepatuhan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><b>Dx.3</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><b>KH : Tidak terjadi penyebaran infeksi </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><b><u>Rencana tindakan : </u></b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Review patologi penyakit fase aktif/tidak aktif, menyebarnya infeksi melalui bronkhus pada jaringan sekitarnya atau melalui aliran darah atau sistem limfe dan potensial infeksi melalui batuk, bersin, tertawa, ciuman atau menyanyi.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -22.5pt;">R : Membantu klien agar klien mau mengerti dan menerima terhadap terapi yang diberikan untuk mencegah komplikasi.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Mengidentifikasi orang-orang yang beresiko untuk terjadinya infeksi seperti anggota keluarga, teman, orang dalam satu perkumpulan.<br />
Memberitahukan kepada mereka untuk mempersiapkan diri untuk mendapatkan terapi pencegahan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -22.5pt;">R : Pengetahuan dan terapi dapat meminimalkan kerentanan terjadinya penyebaran</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Anjurkan klien menampung dahaknya jika batuk</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;">R : Kebiasaan ini untuk mencegah terjadinya penularan infeksi.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Gunakan masker setiap melakukan tindakan</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;">R : Masker dapat mengurangi resiko penyebaran infeksi</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Monitor temperatur</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 103.5pt; text-align: justify; text-indent: -31.5pt;">R : untuk mengetahui adanya indikasi terjadinya infeksi. Febris merupakan indikasi terjadinya infeksi.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Kolaborasi Pemberian terapi untuk anak</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;">R : Kerja sama akan mempercepat proses penyembuhan</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Monitor sputum BTA. Klien dengan 3 kali pemeriksaan BTA negatif, terapi diteruskan sampai batas waktu yang ditentukan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 103.5pt; text-align: justify; text-indent: -31.5pt;">R : Pemantauan untuk terapi yang akan dilaksanakan selanjutnya</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 18pt;"><b>Dx.4</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 18pt;"><b>KH : Orang tua dan anak akan mengikuti pedoman terapi</b> </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 40.5pt; text-align: justify; text-indent: 13.5pt;"><b><u>Rencana tindakan : </u></b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Kaji seberapa banyak pengetahuan dan yang dimiliki orang tua dan anak tentang TB dan hal ketidakpahaman yang dimiliki</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin: 0cm -21.6pt 0.0001pt 90pt; text-align: justify; text-indent: -18pt;">R : pengkajian membantu menentukan apa yang orang tua dan anak butuhkan untuk belajar agar dapat membantu mereka memenuhi pengobatan jangka panjang.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Ajarkan orang tua dan anak (jika tepat) tentang program pengobatan dan alasan menjalani pengobatan dengan tuntas, dan yakinkan tentang pendidikan yang diperlukan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -22.5pt;">R : Pendidikan dan penguatan diberikan pada orang tua dan anak dengan informasi perlunya mengikuti program pengobatan dengan tuntas dan menurunkan risiko kegagalan akibat defisit pengetahuan. </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Identifikasi alternatif pemberi layanan yang dapat memberikan pengobatan anak jika diperlukan </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin: 0cm -14.4pt 0.0001pt 94.5pt; text-align: justify; text-indent: -22.5pt;">R : hak ini akan menurunkan risiko pengabaiyan dosis yang dilakukan anak selama pengobatan</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 18pt;"><b>Dx.5</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: -54pt;"><b>Tujuan : Klien akan menunjukkan peningkatan status gizi dan BB meningkat.</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 85.5pt; text-align: justify; text-indent: -31.5pt;"><b>KH : Keluarga klien dapat menjelaskan penyebab gangguan nutrisi yang dialami klien, pemulihan kebutuhan nutrisi, susunan menu dan pengolahan makanan sehat seimbang. Dengan bantuan perawat, keluarga klien dapat mendemonstrasikan pemberian diet (per sonde/per oral) sesuai program dietetik.</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 22.5pt; text-align: justify; text-indent: 30pt;"><b><u>Rencana Tindakan:</u></b></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengukur dan mencatat BB pasein</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : BB menggambarkan status gizi pasien</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menyajikan makanan dalam porsi kecil tapi sering</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Sebagai masukan makanan sedikit-sedikit dan mencegah muntah</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menyajikan makanan yang dapat menimbulkan selera makan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Sebagai alternatif meningkatkan nafsu makan pasien</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberikan makanan tinggi TKTP</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Protein mempengaruhi tekanan osmotik pembuluh darah</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberi motivasi kepada pasien agar mau makan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Alternatif lain meningkatkan motivasi pasein untuk makan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan perawatan oral sebelum dan sesudah terapi respirasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Mengurangi rasa yang tidak enak dari sputum atau obat-obat yang digunakan untuk pengobatan yang dapat merangsang vomiting.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jelaskan kepada keluarga tentang penyebab malnutrisi, kebutuhan nutrisi pemulihan, susunan menu dan pengolahan makanan sehat seimbang, tunjukkan contoh jenis sumber makanan ekonomis sesuai status sosial ekonomi klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Meningkatkan pemahaman keluarga tentang penyebab dan kebutuhan nutrisi untuk pemulihan klien sehingga dapat meneruskan upaya terapi dietetik yang telah diberikan selama hospitalisasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tunjukkan cara pemberian makanan per sonde, beri kesempatan keluarga untuk melakukannya sendiri.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 99pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Meningkatkan partisipasi keluarga dalam pemenuhan kebutuhan nutrisi klien, mempertegas peran keluarga dalam upaya pemulihan status nutrisi klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Laksanakan pemberian roborans sesuai program terapi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Roborans meningkatkan nafsu makan, proses absorbsi dan memenuhi defisit yang menyertai keadaan malnutrisi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">j.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Timbang berat badan, ukur lingkar lengan atas dan tebal lipatan kulit setiap pagi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Menilai perkembangan masalah klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberi makan lewat parenteral ( D 5% )</span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Mengganti zat-zat makanan secara cepat melalui parenteral</span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 18pt;"><b>Dx.6</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 18pt;"><b>KH : Orang tua tetap dapat menjalankan perannya</b> </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 18pt;"><b><u>Rencana tindakan : </u></b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin: 0cm -21.6pt 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><b>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Ajarkan orang tua tentang tekhnik isolasi yang benar</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin: 0cm -28.8pt 0.0001pt 90pt; text-align: justify; text-indent: -18pt;">R : pemahaman dan mengikuti teknis isolasi dengan benar membantu mencegah penularan TB yang memungkinkan orang tua bersama selama mungkin dengan anaknya, akan mengurangi perpisahan</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><b>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b>Motivasi orang tua dan anggota keluarga lainnya untuk mengunjungi anak secara teratur.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 99pt; text-align: justify; text-indent: -27pt;">R : seringnya keluarga kontak akan mengurangi kecemasan terhadap perpisahan. </div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 53.45pt; text-align: justify; text-indent: -18pt;"><b>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Implementasi </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;">Pelaksanaan keperawatan merupakan kegiatan yang dilakukan sesuai dengan rencana yang telah ditetapkan. Selama pelaksanaan kegiatan dapat bersifat mandiri dan kolaboratif. Selama melaksanakan kegiatan perlu diawasi dan dimonitor kemajuan kesehatan klien.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 53.45pt; text-align: justify; text-indent: -18pt;"><b>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Evaluasi </b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 36pt;">Tahap evaluasi dalam proses keperawatan menyangkut pengumpulan data subyektif dan obyektif yang akan menunjukkan apakah tujuan pelayanan keperawatan sudah dicapai atau belum. Bila perlu langkah evaluasi ini merupakan langkah awal dari identifikasi dan analisa masalah selanjutnya.</div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><b><span style="font-size: 14pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><b><span style="font-size: 14pt; line-height: 150%;">PENUTUP</span></b></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; text-align: center;"><br />
</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><b>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Kesimpulan</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Dari pembahasan diatas dapat disimpulkan sebagai berikut :</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Penyakit Tuberkulosis (TBC) adalah penyakit infeksi kronis menular yang masih tetap merupakan masalah kesehatan masyarakat di dunia termasuk Indonesia.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>TBC pada anak masih merupakan penyakit mayor yang menyebabkan kesakitan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Besarnya kasus TBC pada anak di Indonesia masih relatif sulit diperkirakan.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Diagnosis TBC tidak dapat ditegakkan hanya dari anamnesis, pemeriksaan fisik atau pemeriksaan penunjang tunggal. Selain alur diagnostik, terdapat pedoman diagnosis dengan menggunakan sistem skoring.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Gambaran klinis TBC pada anak: badan turun, Nafsu makan turun, demam tidak tinggi dapat disertai keringat malam, pembesaran kelenjar limfe superfisialis yang tidak sakit, batuk lama lebih dari 30 hari.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Uji tuberkulin positif bila indurasi > 10 mm (pada gizi baik), atau > 5 mm pada gizi buruk. Uji tuberkulin positif menunjukkan TBC.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tatalaksana TBC pada anak merupakan suatu kesatuan yang tidak dapat dipisahkan antara pemberian medikamentosa, penataaan gizi dan lingkungan sekitarnya</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Obat TBC yang digunakan yaitu Obat TBC utama (first line) rifampisin, INH, pirazinamid, etambutol, dan streptomisin. Obat TBC lain (second line): PAS, viomisin, sikloserin, etionamid, kanamisin, dan kapriomisin yang digunakan jika terjadi multi drug resistance.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pada keadaan meningitis TBC, milier TBC, penyebaran bronkogen, pleuritis TBC, pleuritis TBC dengan keadaan umum jelek ditambah teapi dengan kortikosteroid.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;">10.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Usaha preventif dilakukan dengan vaksin BCG dan kemoprofilaksis. Keterlambatan motorik kasar menunjukkan adanya kerusakan pada susunan saraf pusat seperti serebral palsi (gangguan motorik yang di sebabkan oleh kerusakan bagian otok yang mengatur otot-otot tubuh)</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><b>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Saran-Saran</b></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Bagi perawat diharapkan dapat melaksanakan asuhan keperawatan sesuai dengan prosedur yang ada.</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;">Bagi para orang tua diharapkan memantau pertumbuhan dan perkembangan anak sejak dini untuk dapat mengetahui adakah gejala-gejala penyakit pada anak teruma pengetahuan tentang penyakit TB.</div><m:smallfrac m:val="off" style="color: magenta;"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DAFTAR PUSTAKA</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span class="author"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Diposting oleh </span></span><span class="fn"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Admin</span></span><span class="author"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">. </span></span><span class="clock"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Minggu : 19 Agustus 2007. Tuberkulosis Pada Anak. </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Artikel Kedokteran,Pediatrik.http://medlinux.blogspot.com/2007/08/tuberkulosis-pada anak.html </span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mansjoer Arif, dkk. 2000. <i>Kapita Selekta Kedokteran.</i> Jilid 2. Jakarta : Media Aesculapius</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Posted By : <span class="fn">Asti</span><span class="post-author"> </span><span class="post-timestamp">di </span></span><a href="http://astiw.blogspot.com/2010/03/sindroma-down.html" title="permanent link"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">08.10</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">. Jumat, 26 Maret 2010.</span><b><span style="font-size: 12pt; line-height: 115%;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Halaman: 14 (9304 hits. <i>Sindrome Down</i>.</span> <a href="http://astiw.blogspot.com/2010/03/sindroma-down.html"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">http://astiw.blogspot.com/2010/03/sindroma-down.html</span></a></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Speer, morgan, kathleen. 2008. <i>Rencana Asuhan Keperawatan Pediatrik Dengan Clinical Pathaway. </i>Edisi ke-3. Jakarta : EGC</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Suriadi, Yulliani, rita. 2006. <i>Asuhan Keperawatan Pada Anak.</i>Edisi ke-2. Jakarta : PT. Percetakan Penebar Swadaya</span></div><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 24pt 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tim Pengajar Ilmu Kesehatan Anak FKUI. 2007. <i>Ilmu Kesehatan Anak</i>. Jilid 2: Cetakan Ke-11. Jakarta : Percetakan Infomedika</span></div><div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 24pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Wong, L.donna, dkk. 2009. <i>Buku Ajar Keperawatan Pediatrik</i>. Vol : 2. Jakarta : EGC.</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac><div style="color: magenta;"></div>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-9373861908668745372011-02-22T02:28:00.000-08:002011-02-22T02:28:39.590-08:00Akep Pneumonia<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">PENDAHULUAN</span></b></div><div align="center" class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoListParagraph" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Latar Belakang </span></b></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gejala-gejala dari pneumonia yang digambarkan oleh <i>Hippocrates</i> (c.460 BC-380BC) : Peripneumonia dan pleuritis dapat diamati jika demam akut,dan jika sakit pada salah satu bagian atau keduanya jika bernapas,jika ada batuk dengan pengeluaran sputum berwarna kemerahan atau kelabu kehitaman atau juga encer,berbusa dan kemerah merahan atau memiliki karakter lain yang berbeda dari keadaan ketika pneumonia menjadi parah,kasus ini terlalu sulit ditolong,jika dia tidak menyingkirkan,jika ada sesak dan sedikit jumlah urine dan bau tajam,berkeringat sekitar leher dan kepala,berkeringat seperti itu keadaan buruk beralih ke mati lemas,rales dan memperoleh siksaan yang sangat dari penyakit tersebut. Bagaimanapun, Hippocrates sendiri mengarahkan pneumonia sebagai suatu penyakit “istilah kuno”. Dia juga melaporkan hasil pengaliran empyema melalui pembedahan.</span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Maimonides </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">(1138-1204 AD) mengamati”dasar gejala-gejala terjadinya pneumonia dan tidak pernah ketinggalan meninjau, demam akut, pita perekat sakit pada samping (pleuritis), laju nafas pendak, denyut yang bergerigi dan batuk”.<span> </span>Gambaran klinik ini sungguh mirip seperti ditemukan dalam buku-buku modern,dan itu memperluas pemikiran tentang pengetahuan kedokteran bertahun-tahun yang lalu ke dalam abad XIX.<span> </span>Bakteri pertama kali ditemukan pada jalan nafas pada individu yang meninggal karena pneumonia oleh <i>Edwin Klebs</i> pada tahun 1875. Pertama kali teridentifikasi dua bakteri penyebab Streptoccocus pneumonia dan Klebsiella pneumonia yang menemukan <i>Carl</i> <i>Friedlander</i><span> </span>dan <i>Albert frankel</i><span> </span>pada tahun 1882 dan 1884, berturut-turut.<span> </span><i>Friedlander</i> pertama kali memperkenalkan pewarnaan gram pada pemeriksaan dasar laboratorium masih digunakan untuk mengidentifikasi dan membagi bakteri. Paper Cristian Gram’s menguraikan cara ini pada tahun 1884 untuk membantu membedakan antara dua bakteri yang berbeda dan menunjukan yang dapat menyebabkan pneumonia dapat lebih dari satu mikroorganisme. </span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sir William Osler</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">, dikenal sebagai ”bapak kedokteran modern” menyadari morbiditi dan mortalitas dari pneumonia,menggambarkan itu sebagai ”kapten dari manusia yang sudah mati”. Bagaimanapun,beberapa kunci perkembangan pada tahun 1900 mengembangkan hasil untuk pneumonia. Dengan perkembangan dari penicillin dan antibiotik yang lain,teknik pembedahan modern,dan perawatan intensif dalam abad ke 20, kematian dari pneumonia menurun dengan cepat pada negara berkembang. Vaksinasi pada bayi terhadap Haemophillus influenza type B mulai tahun 1988 dan penurunan yang dramatik pada kasus-kasus sesudahnya.<span> </span>Vaksinasi terhadap Streptoccocus pneumonia pada orang dewasa mulai tahun 1977 dan pada anak-anak mulai tahun 2000, hasilnya menunjukan penurunan yang sama. </span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia merupakan suatu penyakit yang terjadi pada semua tempat di dunia. Merupakan salah satu kasus terbesar penyebab kematian pada semua kelompok umur. Pada anak-anak, mayoritas penyebab kematian yang terjadi pada saat kelahiran dengan lebih dari 2 juta kematian dalam setahun meliputi seluruh dunia. Organisasi kesehatan dunia (WHO) memperkirakan 1 dari 3 kelahiran bayi meninggal akibat pneumonia. Kematian akibat pneumonia umumnya berkurang pada umur paling hingga masa dewasa. Orang lanjut usia,kadang-kadangada resiko khusus terhadap pneumonia dan dihubungkan dengan kematian. Lagi pula kasus pneumonia terjadi selama musim dingin daripada waktu lain sepanjang tahun. Pneumonia biasanya sering terjadi pada laki-laki daripada wanita, dan seringkali pada orang kulit hitam daripada kaukasian. Individu dengan penyakit utama seperti penyakit alzheimer’s,f ibrosis kistik, emphysema, perokok tembakau, alkoholisme atau masalah dengan sistem imun menambah resiko terjadinya pneumonia. Individu-individu ini juga mungkin dapat terjadi pneumonia yang berulang. Orang yang masuk rumah sakit dengan sedikit alasan juga resiko tinggi terhadap pneumonia.</span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Rumusan Masalah </span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Berdasarkan latar belakang diatas dimana pneumonia merupakan suatu penyakit yang terjadi pada semua tempat di dunia dan merupakan salah satu kasus terbesar penyebab kematian pada semua kelompok umur, maka kami merumuskan permasalahan sebagai berikut :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bagaimana konsep penyakit pneumonia tersebut? (khususnya pada anak).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bagamana memberikan asuhan keperawatan pada anak dengan pneumonia ?</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tujuan </span></b></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dari latar belakang dan rumusan masalah diatas, diharapkan mahasiswa dapat mengetahui dan memahami baik konsep penyakit pneumonia maupun konsep<span> </span>keperawatan pada klien dengan pneumonia.</span></div><b style="color: orange;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></b> <div class="MsoNormal" style="color: orange;"><br />
</div><div align="center" class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">KONSEP PENYAKIT</span></b></div><div align="center" class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoListParagraph" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pengertian Pneumonia </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;">Pneumonia adalah suatu peradangan atau inflamasi pada parenkim paru yang<br />
umumnya disebabkan oleh agent infeksi. Pneumonia merupakan infeksi akut yang secara anatomi mengenai lobus paru. Pneumonia pada anak seringkali bersamaan terjadinya proses infeksi akut pada bronchus dan disebut bronchopneumonia.<span> </span>Tubuh mempunyai daya tahan yang berguna untuk melindungi dari bahaya infeksi melalui mekanisme daya tahan traktus respiratorius yang terdiri dari :</div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Susunan anatomis dari rongga hidung.</div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Jaringan limfoid di naso-oro-faring.</div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Bulu getar yang meliputi sebagian besar epitel traktus respiratorius dan sekret yang dikeluarkan oleh sel epitel tersebut.</div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Refleks batuk.</div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Refleks epiglotis yang mencegah terjadinya aspirasi sekret yang terinfeksi.</div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Drainase sistem limfatik dan fungsi menyaring kelenjar limfe regional.</div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Fagositas, aksi enzimatik dan respons imunohumoral terutama dari IgA.</div><div class="MsoBodyText" style="color: orange; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Klasifikasi Pneumonia</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia berdasarkan penyebab :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia bakteri.<span></span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia virus.<span></span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia Jamur.<span></span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia aspirasi.<span></span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia hipostatik.<span></span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia berdasarkan anatomic<b> :</b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia lobaris adalah radang paru-paru yang mengenai sebagian besar/seluruh lobus paru-paru.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia lobularis (bronchopneumonia) adalah radang pada paru-paru yang mengenai satu/beberapa lobus paru-paru yang ditandai dengan adanya bercak-bercak infiltrate.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia interstitialis (bronkhiolitis) adalah<span> </span>radang pada dinding alveoli (interstitium) dan peribronkhial dan jaringan interlobular.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 40.5pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Etiologi Pneumonia</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Umumnya adalah bakteri, yaitu Streptococcus pneumoniae dan Haemophillus influenza. Pada bayi dan anak kecil ditemukan Staphylococcus aureus sebagai penyebab pneumonia yang berat, serius dan progresif dengan mortalitas tinggi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Klasifikasi pneumonia pada anak menurut etiologi</span></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="LightList1" style="border-collapse: collapse; border: medium none; color: orange; margin-left: 14.4pt;"><tbody>
<tr> <td style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: black none repeat scroll 0% 0%; border-color: black -moz-use-text-color -moz-use-text-color black; border-style: solid none none solid; border-width: 1pt medium medium 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jenis</span></div></td> <td style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: black none repeat scroll 0% 0%; border-color: black black -moz-use-text-color -moz-use-text-color; border-style: solid solid none none; border-width: 1pt 1pt medium medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Mikroorganisme</span></div></td> </tr>
<tr> <td style="border-color: black -moz-use-text-color black black; border-style: solid none solid solid; border-width: 1pt medium 1pt 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bakteri </span></b></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumokokus, Streptokokus, Stafilokokus, Haemophilus influenza, Pseudomonas aeruginosa</span></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color -moz-use-text-color -moz-use-text-color black; border-style: none none none solid; border-width: medium medium medium 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Virus atau kemungkinan virus</span></b></div></td> <td style="border-color: -moz-use-text-color black -moz-use-text-color -moz-use-text-color; border-style: none solid none none; border-width: medium 1pt medium medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Respiratory syncitial virus, Adenovirus, Sitomegalovirus, Virus influenza</span></div></td> </tr>
<tr> <td style="border-color: black -moz-use-text-color black black; border-style: solid none solid solid; border-width: 1pt medium 1pt 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonitis interstisialis dan bronkiolitis</span></b></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumocystis carinii pneumonia, Q fever, Mycoplasma pneumoniae pneumonia, Klamidia, dll.</span></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color -moz-use-text-color -moz-use-text-color black; border-style: none none none solid; border-width: medium medium medium 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Infeksi lain</span></b></div></td> <td style="border-color: -moz-use-text-color black -moz-use-text-color -moz-use-text-color; border-style: none solid none none; border-width: medium 1pt medium medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div></td> </tr>
<tr> <td style="border-color: black -moz-use-text-color black black; border-style: solid none solid solid; border-width: 1pt medium 1pt 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jamur </span></b></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Aspergilus, Koksidioidomikosis, Histoplasma, dll</span></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color -moz-use-text-color -moz-use-text-color black; border-style: none none none solid; border-width: medium medium medium 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Aspirasi </span></b></div></td> <td style="border-color: -moz-use-text-color black -moz-use-text-color -moz-use-text-color; border-style: none solid none none; border-width: medium 1pt medium medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Cairan amnion, makanan, cairan lambung, benda asing. </span></div></td> </tr>
<tr> <td style="border-color: black -moz-use-text-color black black; border-style: solid none solid solid; border-width: 1pt medium 1pt 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sindrom loeffler</span></b></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color -moz-use-text-color -moz-use-text-color black; border-style: none none none solid; border-width: medium medium medium 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia hipostatik </span></b></div></td> <td style="border-color: -moz-use-text-color black -moz-use-text-color -moz-use-text-color; border-style: none solid none none; border-width: medium 1pt medium medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div></td> </tr>
<tr> <td style="border-color: black -moz-use-text-color black black; border-style: solid none solid solid; border-width: 1pt medium 1pt 1pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia oleh obat/radiasi</span></b></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div></td> </tr>
<tr style="height: 3pt;"> <td style="border-color: -moz-use-text-color -moz-use-text-color black black; border-style: none none solid solid; border-width: medium medium 1pt 1pt; height: 3pt; padding: 0cm 5.4pt; width: 182.05pt;" valign="top" width="243"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia hipersensitivitas</span></b></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 3pt; padding: 0cm 5.4pt; width: 222.95pt;" valign="top" width="297"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
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</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Patofisiologi</b> <b>Pneumonia</b></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;">Sebagian besar pneumonia didapat melalui aspirasi partikel infektif. Ada beberapa mekanisma yang pada keadaan normal melindungi paru dari infeksi. Partikel infeksius difiltrasi di hidung, atau terperangkap dan dibersihkan oleh mukus dan epitel bersilia di saluran napas. Bila suatu partikel dapat mencapai paru-paru, partikel tersebut akan berhadapan dengan makrofag alveoler, dan juga dengan mekanisme imun sistemik, dan humoral. Bayi pada bulan-bulan pertama kehidupan juga memiliki antibodi maternal yang didapat secara pasif yang dapat melindunginya dari pneumokokus dan organisme-organisme infeksius lainnya.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;">Perubahan pada mekanisme protektif ini dapat menyebabkan anak mudah mengalami pneumonia misalnya pada kelainan anatomis kongenital, defisiensi imun didapat atau kongenital, atau kelainan neurologis yang memudahkan anak mengalami aspirasi dan perubahan kualitas sekresi mukus atau epitel saluran napas. Pada anak tanpa faktor-faktor predisposisi tersebut, partikel infeksius dapat mencapai paru melalui perubahan pada pertahanan anatomis dan fisiologis yang normal. Ini paling sering terjadi akibat virus pada saluran napas bagian atas. Virus tersebut dapat menyebar ke saluran napas bagian bawah dan menyebabkan pneumonia virus.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;">Kemungkinan lain, kerusakan yang disebabkan virus terhadap mekanisme pertahan yang normal dapat menyebabkan bakteri patogen menginfeksi saluran napas bagian bawah. Bakteri ini dapat merupakan organisme yang pada keadaan normal berkolonisasi di saluran napas atas atau bakteri yang ditransmisikan dari satu orang ke orang lain melalui penyebaran droplet di udara. Kadang-kadang pneumonia bakterialis dan virus ( contoh: varisella, campak, rubella, CMV, virus Epstein-Barr, virus herpes simpleks ) dapat terjadi melalui penyebaran hematogen baik dari sumber terlokalisir atau bakteremia/viremia generalisata.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;">Setelah mencapai parenkim paru, bakteri menyebabkan respons inflamasi akut yang meliputi eksudasi cairan, deposit fibrin, dan infiltrasi leukosit polimorfonuklear di alveoli yang diikuti infitrasi makrofag. Cairan eksudatif di alveoli menyebabkan konsolidasi lobaris yang khas pada foto toraks. Virus, mikoplasma, dan klamidia menyebabkan inflamasi dengan dominasi infiltrat mononuklear pada struktur submukosa dan interstisial. Hal ini menyebabkan lepasnya sel-sel epitel ke dalam saluran napas, seperti yang terjadi pada bronkiolitis.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Manifestasi Klinis Pneumonia</span></b></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Secara umum dapat dibagi menjadi :</span></div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Manifestasi nonspesifik infeksi dan toksisitas berupa demam, sakit kepala, iritabel, gelisah, malaise, nafsu makan kurang, keluhan gastrointestinal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gejala umum saluran pernapasan bawah berupa batuk, takipnu, ekspektorasi sputum, napas cuping hidung, sesak napas, air hunger, merintih, dan sianois. Anak yang lebih besar dengan pneumonia akan lebih suka berbaring pada sisi yang sakit dengan lutut tertekuk karena nyeri dada.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tanda pneumonia berupa retraksi (penarikan dinding dada bagian bawah kedalam saat bernapas bersama dengan peningkatan frekwensi napas.), perkusi pekak, fremitus melemah, suara napas melemah, dan ronkhi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tanda efusi pleura atau empiema berupa gerak ekskursi dada tertinggal di daerah efusi, perkusi pekak, fremitus melemah, suara napas melemah, suara napas tubuler tepat diatas bata cairan, friction rub, nyeri dada karena iritasi pleura (nyeri berkurang bila efusi bertambah dan berubah menjadi nyeri tumpul), kaku kuduk/meningismus (iritasi meningen tanpa inflamasi) bila terdapat iritasi pleura lobus atas, nyeri abdomen (kadang terjadi bila iritasi mengenai diafragma pada pneumonia lobus kanan bawah). Pada neonatus dan bayi kecil tanda pnemoni tidak terlalu jelas. Efusi pleura pada bayi akan menimbulkan pekak perkusi.</span></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tanda infeksi ekstra pulmonal. </span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gejala khas</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> : </span></div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sianosis pada mulut dan hidung.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sesak nafas, takipnea (25 – 45 kali/menit) disertai pernafasan cuping hidung.</span></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gelisah, cepat lelah.</span></div><div class="MsoListParagraph" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Insiden </span></b></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia merupakan salah satu penyebab utama kesakitan dan kematian pada anak kurang dari 5 tahun. Diperkirakan sekitar 20% (1,9 juta) kematian pertahun dari anak-anak usia kurang dari 5 tahun ini disebabkan oleh pneumonia. Dan hampir 2/3-nya terjadi pada bayi, dan lebih dari 90% terjadi di negara-negara berkembang.</span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Zinc merupakan mineral yang mempunyai potensi untuk meningkatkan status imunologi, mencegah dan memperpendek waktu diare. Efek zinc sebagai <i>imunomodulator</i> ini diperkirakan memberikan manfaat untuk membantu mempercepat penyembuhan infeksi maupun mencegah kekambuhan, zinc membantu meningkatkan daya tahan tubuh melalui langkah-langkah yang diawali dengan mobilisasi dan skuestrasi dari zinc pada jaringan kaya zinc-metallomethionin, selanjutnya akan mempercepat upregulasi sintesis protein sebagai bahan untuk imun spesifik, serta aktivasi dari makrofag, limfosit, dan sel NK. </span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Anak-anak dengan status zinc yang baik secara umum mempunyai respon imunologis lebih baik jika dibandingkan dengan anak-anak dengan status zinc yang lebih jelek. Jika dari data saat ini penggunaan zinc merupakan salah satu acuan dalam penanganan diare, bagaimana halnya manfaat zinc untuk kasus pneumonia ? Manfaat zinc dalam mencegah terjadinya pneumonia diantaranya dibuktikan dalam studi yang dilakukan oleh Brooks WA.dkk., dan dipublikasikan dalam Jurnal The Lancet. Dalam studi yang melibatkan sebanyak 270 anak-anak dengan pneumonia ini, rentang usia antara 2 – 23 bulan, masing-masing diberikan preparat zinc 20 mg per hari atau mendapat plasebo, yang ditambahkan pada terapi antibiotik menunjukkan bahwa pada kelompok yang mendapat preparat zinc terjadi penurunan darajat keparahan dari pneumonia-nya serta terjadi penurunan gejala-gejala pneumonia yang lebih bermakna jika dibandingkan dengan kelompok anak yang mendapat plasebo.Sedangkan studi yang lain adalah studi yang melibatkan sebanyak 1665 anak dengan rentang usia 60 hari - 12 bulan, yang selanjutnya diacak untuk mendapatkan zinc sebanyak 70 mg/ minggu atau mendapat plasebo selama 12 bulan. Subyek dinilai setiap minggu dengan beberapa parameter yang diukur adalah meliputi: kejadian diare dan pneumonia, serta kejadian infeksi saluran nafas.Dalam studi tersebut terbukti suplementasi zinc mampu mencegah terjadinya diare (95% CI 0,94(0,88-0,99;p=0,03), mencegah pneumonia berat (95% CI 0,51(0,3-0,88);p=0,016), maupun mencegah kematian (95% CI 0,15(0,3-0,67);p=0,013).</span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dari studi tersebut dapat disimpulkan bahwa: suplementasi zinc 20 mgper hari atau sebesar 70 mg per minggunya, mampu menurunkan kejadian pneumonia serta kematian pada anak-anak.</span></div><div class="MsoListParagraph" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Komplikasi </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bila tidak ditangani secara tepat<span> </span>maka akan dapat menimbulkan :</span></div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Otitis media akut (OMA), terjadi bila tidak diobati, maka sputum yang berlebihan akan masuk ke dalam tuba eustachius, sehingga menghalangi masuknya udara ke telinga tengah dan mengakibatkan hampa udara, kemudian gendang telinga akan tertarik ke dalam dan timbul efusi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Efusi pleura</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Emfisema</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Meningitis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Abses otak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Endokarditis</span></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Osteomielitis</span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pemeriksaan Diagnostik</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sinar X : mengidentifikasikan distribusi struktural (misal: lobar, bronchial); dapat juga menyatakan abses).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pemeriksaan gram/kultur, sputum dan darah: untuk dapat mengidentifikasi semua organisme yang ada.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pemeriksaan serologi: membantu dalam membedakan diagnosis organisme khusus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pemeriksaan fungsi paru: untuk mengetahui paru-paru, menetapkan luas berat penyakit dan membantu diagnosis keadaan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Biopsi paru: untuk menetapkan diagnosis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Spirometrik static: untuk mengkaji jumlah udara yang diaspirasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bronkostopi: untuk menetapkan diagnosis dan mengangkat benda asing.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Terapi Penatalaksanaan </span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Oksigen 1-2L/ menit</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">IVFD dekstrose 10% :NaCL0,9% =3 :1,+KCL 10 mEq/500 ml cairan.jumlah cairan sesuai berat badan,kenaikan suhu,dan status hidrasi.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jika sesak tidak terlalu hebat,dapat dimulai makanan enteral bertahap melalui selang nasogastrik dengan feeding drip.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jika sekresi lender berlebihan dapat diberikan inhalasi dengan salin normal dan beta agonis untuk memperbaiki transpor mukosilier.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Koreksi gangguan keseimbangan asam basa dan elektrolit.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Antibiotic sesuai hasil biakan.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Untuk kasus pneumonia community base :</span></div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Ampisilin 100 mg/kgBB/hari dalam 4 kali pemberian.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kloramfenikol 75 mg/kgBB/hari dalam 4 kali pemberian.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Untuk kasus pneumonia hospital base :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sefoktaksim 100 mg/kgBB/hari dalam 2 kali pemberian.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Amikasin 10-15 mg/kgBB/hari dalam 2 kali pemberian.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pemilihan antibiotika berdasarkan etiologi.</span></div><table border="1" cellpadding="0" cellspacing="0" class="LightList1" style="border-collapse: collapse; border: medium none; color: orange; margin-left: 5.4pt;"><tbody>
<tr> <td style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: black none repeat scroll 0% 0%; border-color: black -moz-use-text-color -moz-use-text-color black; border-style: solid none none solid; border-width: 1pt medium medium 1pt; padding: 0cm 5.4pt; width: 210.2pt;" valign="top" width="280"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Mikoroorganisme </span></b></div></td> <td style="-moz-background-clip: border; -moz-background-inline-policy: continuous; -moz-background-origin: padding; background: black none repeat scroll 0% 0%; border-color: black black -moz-use-text-color -moz-use-text-color; border-style: solid solid none none; border-width: 1pt 1pt medium medium; padding: 0cm 5.4pt; width: 212.8pt;" valign="top" width="284"> <div class="MsoListParagraph" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Antibiotic</span></b></div></td> </tr>
<tr style="height: 143pt;"> <td style="border-color: black -moz-use-text-color black black; border-style: solid none solid solid; border-width: 1pt medium 1pt 1pt; height: 143pt; padding: 0cm 5.4pt; width: 210.2pt;" valign="top" width="280"> <div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Streptokokus dan </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Stafilkokus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">M<b>. </b>pnemoniae</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">H. influenzae </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Klebsiella</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">P. aeruginosa</span></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 143pt; padding: 0cm 5.4pt; width: 212.8pt;" valign="top" width="284"> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penisilin G 50.000 unit/hari iv atau </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penisilin Prokain 600.000U/kali/hari im atau Ampisilin 100 mg/kgBB/hari</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Seftriakson 75-200 mg/kgBB/hari</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Eritromisin 15 mg/kgBB/hari atau derivatnya</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kloramfenikol 100mg/kgBB/hari atau sefalosforin</span></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Catatan : </span></b></div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pengobatan diberikan selama 7-10 hari pada kasusu tanpa komplikasi.</span></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pneumonia ringan tidak memerlukan perawatan dan diberikan antibiotika oral golongan derivatnya atau kotrimoksazol.<span> </span></span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Prognosa : </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">dengan pemberian antibiotic yang tepat, mortalitas dapat menurun.</span></div><b style="color: orange;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><br clear="all" style="page-break-before: always;" /> </span></b> <div class="MsoNormal" style="color: orange;"><br />
</div><div align="center" class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">BAB III</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">KONSEP<span> </span>KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pengkajian</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Biodata</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Identitas Klien, meliputi :</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nama/Nama panggilan </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tempat tgl lahir/usia </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jenis kelamin</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">A g a m a</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pendidikan<span> </span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Alamat</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>7)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tgl/jam masuk</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>8)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tgl pengkajian</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>9)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Diagnosa medik </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>10)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Rencana terapi<span> </span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Identitas Orang tua</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Ayah </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="ES" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Ibu</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Riwayat Kesehatan </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Adanya riwayat infeksi saluran pernafasan sebelumnya/batuk, pilek, takhipnea, demam.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Anoreksia, sukar menelan, muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Riwayat penyakit yang berhubungan dengan imunitas, seperti ; morbili, pertusis, malnutrisi, imunosupresi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Anggota keluarga lain yang mengalami sakit saluran pernafasan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Batuk produktif, pernafasan cuping hidung, pernafasan cepat dan dangkal, gelisah, sianosis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Faktor Psikososial/Perkembangan </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Usia, tingkat perkembangan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Toleransi/kemampuan memahami tindakan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Koping</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pengalaman berpisah dengan keluarga/orang tua.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pengalaman infeksi saluran pernafasan sebelumnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pengetahuan Keluarga, Psikososial </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tingkat pengetahuan keluarga tentang penyakit bronchopneumonia.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pengalaman keluarga dalam menangani penyakit saluran pernafasan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kesiapan/kemauan keluarga untuk belajar merawat anaknya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Koping keluarga</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tingkat kecemasan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pemeriksaan Fisik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Aktivitas/istirahat<br />
Gejala : kelemahan, kelelahan, insomnia<span> </span><br />
Tanda : letargi, penurunan toleransi terhadap aktivitas. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sirkulasi<br />
Gejala : riwayat adanya<span> </span><br />
Tanda : takikardia, penampilan kemerahan, atau pucat </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Makanan/cairan<br />
Gejala : kehilangan nafsu makan, mual, muntah, riwayat diabetes mellitus<span> </span><br />
Tanda : sistensi abdomen, kulit kering dengan turgor buruk, penampilan kakeksia (malnutrisi) </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Neurosensori<br />
Gejala : sakit kepala daerah frontal (influenza)<span> </span><br />
Tanda : perusakan mental (bingung) </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nyeri/kenyamanan<br />
Gejala : sakit kepala, nyeri dada (meningkat oleh batuk), imralgia, artralgi<span> </span><br />
Tanda : melindungi area yang sakit (tidur pada sisi yang sakit untuk membatasi gerakan) <span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pernafasan<br />
Gejala : adanya riwayat ISK kronis, takipnea (sesak nafas), dispnea.<span> </span><br />
Tanda :<span> </span>sputum: merah muda, berkarat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">perpusi: pekak datar area yang konsolidasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">premikus: taksil dan vocal bertahap meningkat dengan konsolidasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bunyi nafas menurun</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span><span> </span>Warna: pucat/sianosis bibir dan kuku </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Keamanan<br />
Gejala : riwayat gangguan sistem imun misal: AIDS, penggunaan steroid, demam.<br />
Tanda : berkeringat, menggigil berulang, gemetar </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penyuluhan/pembelajaran<br />
Gejala : riwayat mengalami pembedahan, penggunaan alkohol kroni<span> </span><br />
Tanda : DRG menunjukkan rerata lama dirawat 6 – 8 hari<span> </span><br />
Rencana pemulangan: bantuan dengan perawatan diri, tugas pemeliharaan rumah </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Diagnosa Keperawatan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bersihan jalan nafas tak efektif berhubungan dengan inflamasi trachea bronchial,<br />
pembentukan edema, peningkatan produksi sputum.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gangguan pertukaran gas berhubungan dengan gangguan kapasitas pembawa oksigen darah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Resiko tinggi terhadap infeksi (penyebaran) berhubungan dengan ketidakadekuatan<br />
pertahanan sekunder (adanya infeksi penekanan imun), penyakit kronis, malnutrisi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Intoleransi aktivitas berhubungan dengan ketidakseimbangan antara suplai dan kebutuhan oksigen. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nyeri (akut) berhubungan dengan inflamasi parenkim paru, batuk menetap.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Resiko tinggi terhadap nutrisi kurang dari kebutuhan berhubungan dengan peningkatan kebutuhan metabolik sekunder terhadap demam dan proses infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Resiko tinggi terhadap kekurangan volume cairan berhubungan dengan kehilangan cairan berlebihan, penurunan masukan oral. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Rencana Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Diagnosa : </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bersihan jalan nafas tak efektif berhubungan dengan inflamasi trachea bronchial, peningkatan produksi sputum, ditandai dengan:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Perubahan frekuensi, kedalaman pernafasan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bunyi nafas tak normal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dispnea, sianosis</span></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Batuk efektif atau tidak efektif dengan/tanpa produksi sputum.</span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tujuan </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span>: jalan nafas efektif </span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kriteria hasil </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">:</span></div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Batuk teratasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nafas normal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bunyi nafas bersih</span></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tidak terjadi Sianosis</span></div><div class="MsoNormal" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">:</span></div><div class="MsoListParagraphCxSpFirst" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kaji frekuensi/kedalaman pernafasan dan gerakan dada<span> </span><br />
<b>Rasional</b> : Takipnea, pernafasan dangkal dan gerakan dada tak simetris sering terjadi karena ketidaknyamanan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Auskultasi area paru, catat area penurunan 1 kali ada aliran udara dan bunyi nafas.<br />
<b>Rasional</b>:<span> </span>Penurunan aliran darah terjadi pada area konsolidasi dengan cairan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Ajarkan teknik batuk efektif<span> </span><br />
<b>Rasional</b> : Batuk adalah mekanisme pembersihan jalan nafas alami untuk mempertahankan jalan nafas paten.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penghisapan sesuai indikasi.<span> </span><br />
<b>Rasional</b>:<span> </span>Merangsang batuk atau pembersihan jalan nafas suara mekanik pada faktor yang tidak mampu melakukan karena batuk efektif atau penurunan tingkat kesadaran.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Berikan cairan sesuai kebetuhan. <span> </span><br />
<b>Rasional:</b><span> </span>Cairan (khususnya yang hangat) memobilisasi dan mengeluarkan secret</span></div><div class="MsoListParagraphCxSpLast" style="color: orange; line-height: normal; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span>6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kolaborasi dengan dokter untuk pemberian obat sesuai indikasi: mukolitik. <br />
<b>Rasional</b>:<span> </span>Alat untuk menurunkan spasme bronkus dengan mobilisasi sekret, analgetik diberikan untuk memperbaiki batuk dengan menurunkan ketidaknyamanan tetapi harus digunakan secara hati-hati, karena dapat menurunkan upaya batuk/menekan pernafasan. </span></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b>Diagnosa : </b>Gangguan pertukaran gas berhubungan dengan gangguan pembawa oksigen darah, gangguan pengiriman oksigen, ditandai dengan:</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Dispnea, sianosis</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Takikardia</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Gelisah/perubahan mental</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Hipoksia </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Tujuan<span> </span>: </b>gangguan gas teratasi<span> </span></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Kriteria hasil :</b></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak nampak sianosis</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nafas normal</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak terjadi sesak</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak terjadi hipoksia</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Klien tampak tenang</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Intervensi</b></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kaji frekuensi/kedalaman dan kemudahan bernafas<span> </span><br />
<b>Rasional</b>: Manifestasi distress pernafasan tergantung pada indikasi derajat keterlibatan paru dan status kesehatan umum.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Observasi warna kulit, membran mukosa dan kuku. Catat adanya sianosis perifer (kuku) atau sianosis sentral.<span> </span><br />
<b>Rasional</b>: sianosis kuku menunjukkan vasokontriksi respon tubuh terhadap demam/menggigil namun sianosis pada daun telinga, membran mukosa dan kulit sekitar mulut menunjukkan hipoksemia sistemik.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kaji status mental.<span> </span><br />
<b>Rasional</b>: gelisah mudah terangsang, bingung dan somnolen dapat menunjukkan hipoksia atau penurunan oksigen serebral.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tinggikan kepala dan dorong sering mengubah posisi, nafas dalam dan batuk efektif.<span> </span><br />
<b>Rasional</b>: tindakan ini meningkat inspirasi maksimal, meningkat pengeluaran secret untuk memperbaiki ventilasi tak efektif.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kolaborasi<br />
Berikan terapi oksigen dengan benar misal dengan nasal plong master, master venturi.<span> </span><br />
<b>Rasional</b>: mempertahankan PaO2 di atas 60 mmHg. O2 diberikan dengan metode yang memberikan pengiriman tepat dalam toleransi pernapasan. </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b>Diagnosa : </b>Resiko tinggi terhadap infeksi (penyebaran) berhubungan dengan ketidakadekuatan pertahanan sekunder (adanya infeksi penekanan imun), penyakit kronis, malnutrisi.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Tujuan</b>: Infeksi tidak terjadi<span> </span></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Kriteria hasil </b>:</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Waktu perbaikan infeksi/kesembuhan cepat<span> </span></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Penularan penyakit ke orang lain tidak ada</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Intervensi:</b></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Pantau tanda vital dengan ketat khususnya selama awal terapi<span> </span><br />
<b>Rasional</b>: selama awal periode ini, potensial untuk fatal dapat terjadi.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tunjukkan teknik mencuci tangan yang baik<span> </span><br />
<b>Rasional</b>: efektif berarti menurun penyebaran/perubahan infeksi.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Batasi pengunjung sesuai indikasi.<span> </span><br />
<b>Rasional</b>: menurunkan penularan terhadap patogen infeksi lain</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Potong keseimbangan istirahat adekuat dengan aktivitas sedang. Tingkatkan masukan nutrisi adekuat.<span> </span><br />
<b>Rasional</b>: memudahkan proses penyembuhan dan meningkatkan tekanan alamiah</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kolaborasi untuk pemberian antibiotic. <span> </span><br />
Berikan antimikrobial sesuai indikasi dengan hasil kultur sputum/darah misal penicillin, eritromisin, tetrasiklin, amikalin, sepalosporin, amantadin.<span> </span><br />
<b>Rasional</b>: Obat digunakan untuk membunuh kebanyakan microbial pulmonia.<span> </span></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b>Diagnosa : </b>Intoleransi aktivitas berhubungan dengan ketidakseimbangan antara suplai dan kebutuhan oksigen ditandai dengan:</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Dispnea</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Takikardia</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Sianosis</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Tujuan</b> :<span> </span>Intoleransi aktivitas teratasi </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Kriteria hasil</b> :</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nafas normal</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Sianosis tidak terjadi</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Irama jantung normal</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Intervensi</b></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Evaluasi respon pasien terhadap aktivitas<span> </span><br />
<b>Rasional</b>: merupakan kemampuan, kebutuhan pasien dan memudahkan pilihan interan.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Berikan lingkungan tenang dan batasi pengunjung selama fase akut sesuai indikasi.<br />
<b>Rasional</b>: menurunkan stress dan rangsangan berlebihan, meningkatkan istirahat.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Bantu pasien memilih posisi nyaman untuk istirahat atau tidur.<span> </span><br />
<b>Rasional</b>: pasien mungkin nyaman dengan kepala tinggi, tidur di kursi.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Bantu aktivitas perawatan diri yang diperlukan<span> </span><br />
<b>Rasional</b>: meminimalkan kelelahan dan membantu keseimbangan suplai dan kebutuhan oksigen. </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b>Diagnosa : </b>Nyeri berhubungan dengan inflamasi parenkim varul, batuk menetap ditandai dengan:</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nyeri dada</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Sakit kepala</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Gelisah</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Tujuan </b>: Nyeri dapat teratasi </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Kriteria hasil</b> :</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nyeri dada teratasi</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Sakit kepala terkontrol</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tampak tenang</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Intervensi</b>:</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tentukan karakteristik nyeri, misal kejan, konstan ditusuk.<span> </span><br />
<b>Rasional</b>: nyeri dada biasanya ada dalam seberapa derajat pada pneumonia, juga dapat timbul karena pneumonia seperti perikarditis dan endokarditis.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Pantau tanda vital<span> </span><br />
<b>Rasional</b>: Perubahan FC jantung/TD menu bawa Pc mengalami nyeri, khusus bila alas an lain tanda perubahan tanda vital telah terlihat.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Berikan tindakan nyaman pijatan punggung, perubahan posisi, musik tenang/berbincangan.<br />
<b>Rasional</b>: tindakan non analgesik diberikan dengan sentuhan lembut dapat menghilangkan ketidaknyamanan dan memperbesar efek derajat analgesik.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Aturkan dan bantu pasien dalam teknik menekan dada selama episode batuk.<br />
<b>Rasional</b>: alat untuk mengontrol ketidaknyamanan dada sementara meningkat keefektifan upaya batuk.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kolaborasi<br />
Berikan analgesik dan antitusik sesuai indikasi<span> </span><br />
<b>Rasional</b>: obat dapat digunakan untuk menekan batuk non produktif atau menurunkan mukosa berlebihan meningkat kenyamanan istirahat umum. </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b>Diagnosa : </b>Resiko tinggi terhadap nutrisi kurang dari kebutuhan tubuh berhubungan dengan peningkatan kebutuhan metabolik sekunder terhadap demam dan proses inflamasi</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Tujuan</b>: Nutrisi<span> </span>tubuh dapat teratasi </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Kriteria hasil</b> :</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Pasien menunjukkan peningkatan nafsu makan</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Pasien mempertahankan meningkat BB</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Intervensi</b> :</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Identifikasi faktor yang menimbulkan mual/muntah, misalnya: sputum, banyak nyeri.<br />
<b>Rasional</b>: pilihan intervensi tergantung pada penyebab masalah</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Jadwalkan atau pernafasan sedikitnya 1 jam sebelum makan.<span> </span><br />
<b>Rasional:</b> menurun efek manual yang berhubungan dengan penyakit ini</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Berikan makan porsi kecil dan sering termasuk makanan kering (roti panggang)<br />
makanan yang menarik oleh pasien.<span> </span><br />
<b>Rasional:</b> tindakan ini dapat meningkat masukan meskipun nafsu makan mungkin lambat untuk kembali.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Evaluasi status nutrisi umum, ukur berat badan dasar.<span> </span><br />
<b>Rasional</b>: adanya kondisi kronis keterbatasan ruangan dapat menimbulkan malnutrisi, rendahnya tahanan terhadap inflamasi/lambatnya respon terhadap terapi. </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b>Diagnosa : </b>Resiko tinggi terhadap kekurangan volume cairan berhubungan dengan kehilangan cairan berlebihan, demam, berkeringat banyak, nafas mulut, penurunan masukan oral.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Tujuan :</b> Kekurangan volume cairan tidak terjadi </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Kriteria hasil</b> : </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;">Pasien menunjukkan keseimbangan cairan dibuktikan dengan parameter individual yang tepat misalnya membran mukosa lembab, turgor kulit baik, tanda vital stabil.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b>Intervensi</b>:</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kaji perubahan tanda vital contoh peningkatan suhu demam memanjang, takikardia.<br />
<b>Rasional</b>: peningkatan suhu/memanjangnya demam meningkat laju metabolik dan kehilangan cairan untuk evaporasi.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kaji turgor kulit, kelembapan membran mukosa (bibir, lidah)<span> </span><br />
<b>Rasional</b>: indikator langsung keadekuatan volume cairan, meskipun membran mukosa mulut mungkin kering karena nafas mulut dan O2 tambahan.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Catat laporan mual/muntah<span> </span><br />
<b>Rasional</b>: adanya gejala ini menurunkan masukan oral</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Pantau masukan dan keluaran catat warna, karakter urine. Hitung keseimbangan cairan. Ukur berat badan sesuai indikasi.<span> </span><br />
<b>Rasional</b>: memberikan informasi tentang keadekuatan volume cairan dan keseluruhan penggantian.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tekankan cairan sedikit 2400 mL/hari atau sesuai kondisi individual<span> </span><br />
<b>Rasional</b>: pemenuhan kebutuhan dasar cairan menurunkan resiko dehidrasi.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Kolaborasi<br />
Beri obat indikasi misalnya antipiretik, antimitik.<span> </span><br />
<b>Rasional</b>: berguna menurunkan kehilangan cairan</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Berikan cairan tambahan IV sesuai keperluan<span> </span><br />
<b>Rasional</b>: pada adanya penurunan masukan banyak kehilangan<span> </span><br />
penggunaan dapat memperbaiki/mencegah kekurangan </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b>Evaluasi</b></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Bersihan jalan nafas efektif ditandai dengan :</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Batuk teratasi</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nafas normal</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Bunyi nafas bersih</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak terjadi sianosis</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak terjadi gangguan pertukaran gas ditandai dengan : </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak nampak sianosis</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nafas normal</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak terjadi sesak</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak terjadi hipoksia</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Klien tampak tenang</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tidak ada resiko terhadap infeksi ditandai dengan :</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Waktu perbaikan infeksi/kesembuhan cepat<span> </span></div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Penularan penyakit ke orang lain tidak ada</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Toleran terhadap<span> </span>aktivitas sehari-hari ditandai dengan : </div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nafas normal</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Sianosis tidak terjadi</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Irama jantung normal</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nyeri (akut) teratasi ditandai dengan :</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nyeri dada teratasi</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Sakit kepala terkontrol</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Tampak tenang</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Nutrisi adekuat ditandai dengan :</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Pasien menunjukkan peningkatan nafsu makan.</div><div style="color: orange; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Pasien mempertahankan meningkat BB.</div><div style="color: orange; 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</style> <![endif]--> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div><div align="center" class="MsoNormal" style="color: orange; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;">DAFTAR PUSTAKA</span></b></div><div align="center" class="MsoNormal" style="color: orange; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><h1 style="color: orange; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">Detik Health. 2009. </span><i><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">Idiopatik Pneumonia Interstisial. </span></i><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">(<a href="http://www.detikhealth.com/">http://www.detikhealth.com/</a>, diakses 14 Desember 2010).</span></h1><h1 style="color: orange; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">Gabs, G. 2010. <i>Askep Anak Pneumonia. </i>(<a href="http://gardengab.com/">http://gardengab.com/</a>, diakses tanggal 10 Desember 2010).</span></h1><h1 style="color: orange; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">KTW. 2010. <i>Suplementasi Zinc Menurunkan Kejadian Pneumonia Pada Anak-anak. </i>(<a href="http://www.kalbe.co.id/advetorial-150-zegase.html">http://www.kalbe.co.id/advetorial-150-zegase.html</a>, diakses 10 Desember 2010).</span></h1><h1 style="color: orange; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">Mansjoer, Arif., Suprohaita, Wardhani, W.A., dan Setiowulan, wiwiek │Eds.│. Kapita Selekta Kedokteran. Jakarta : Media Auscalapius.</span></h1><h1 style="color: orange; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">Prasetya, Danzka. <i>Askep Pneumonia. </i>(<a href="http://wildanprasetya.blog.com/">http://wildanprasetya.blog.com/</a>, diakses 10 Desember 2010).</span></h1><b style="color: orange;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Staf Pengajar Ilmu Kesehatan Anak. 1985. <i>Buku Kuliah 3 Ilmu Kesehatan Anak</i>.<span> </span><span> </span>Jakarta:<span> </span>Fakultas Kedokteran Universitas Indonesia.</span></b> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-52308706956257013182011-02-21T04:10:00.000-08:002011-02-21T04:10:05.706-08:00Askep Menengitis<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Meningitis ialah radang pada bagian meningen yaitu selaput otak dan saraf tunjang. Penyakit ini disebabkan oleh jangkitan virus atau juga bakteria. <br />
Meningitis yang disebabkan oleh virus lazimnya kurang kronik dan pulih tanpa perawatan yang spesifik. Meningitis yang disebabkan oleh bakteria agak serius dan mungkin membawa kepada kerusakan otak, hilang pendengaran, kurang upaya pembelajaran dan membawa maut.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Pada permulaan penyakit dikalangan anak-anak, anak akan mengeluh demam dan sakit kepala. Anak berumur kurang dari setahun hanya menangis berlebihan, demam dan enggan minum. Semua tanda-tanda awal bagi anak berumur kurang dari setahun sama dengan tanda tanda penyakit lain seperti pneumonia, infeksi telinga, bronkiolitis dan infeksi saluran kencing.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Oleh itu, hanya apabila dokter berpendapat bahwa seorang mengidap meningitis ia akan meminta agar lumbal punksi dilakukan. Lumbal punksi adalah prosedur pemeriksaan cairan selaput otak, dengan memasukkan jarum halus ke dalam tulang belakang pasien. Pemeriksaan ini hanya akan dilakukan apabila keadaan tidak membahayakan klien.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rumusan Masalah</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif";">Adapun rumusan masalah dari makalah ini yaitu:</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Bagaimana konsep penyakit meningitis?.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Bagaimana asuhan keperawatan pada penyakit meningitis?.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Adapun tujuan dari makalah ini yaitu:</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Agar mengethui bagaimana konsep penyakit meningitis</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Agar mengetahui asuhan keperawatan pada penyakit meningitis sehingga dapat diaplikasikan di Rumah Sakit</span></div><div class="MsoNormal" style="color: yellow; line-height: 150%;"><br />
</div><div align="center" class="MsoNormal" style="color: yellow; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: yellow; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">MENINGITIS</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: yellow; line-height: 150%; margin-left: 27pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KONSEP PENYAKIT</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.1.1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Definisi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif";">Meningitis adalah radang pada meningen (membran yang mengelilingi otak dan medula spinalis) dan disebabkan oleh virus, bakteri atau organ-organ jamur (Smeltzer, 2001).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif";">Meningitis adalah infeksi cairan otak disertai radang yang mengenai piamater,araknoid dan dalam derajat yang lebih ringan mengenai jaringan otak dan medulla spinalis yang superficial.(neorologi kapita selekta,1996)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif";">Meningitis adalah suatu peradangan araknoid dan piameter (lepto meningens) dari otak dan medulla spinalis. Bakteri dan virus merupakan penyebab yang paling umum dari meningitis, meskipun jamur dapat juga menyebabkan. Meningitis bakteri lebih sering terjadi. Deteksi awal dan pengobatan akan lebih memberikan hasil yang lebih baik menurut Wahyu Widagdo dkk (2008:105)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.1.2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: 31.5pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Meningitis yang disebabkan oleh virus umumnya tidak berbahaya, akan pulih tanpa pengobatan dan perawatan yang spesifik. Namun Meningitis disebabkan oleh bakteri bisa mengakibatkan kondisi serius, misalnya kerusakan otak, hilangnya pendengaran, kurangnya kemampuan belajar, bahkan bisa menyebabkan kematian. Sedangkan Meningitis disebabkan oleh jamur sangat jarang, jenis ini umumnya diderita orang yang mengalami kerusakan immun (daya tahan tubuh) seperti pada penderita AIDS</span></span><span style="font-family: "Times New Roman","serif";"><a href="http://penyakit-pengobatan.blogspot.com/2007/12/penyakit-aids.html">AIDS</a><span class="fullpost"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 9pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Bakteri yang dapat mengakibatkan serangan meningitis diantaranya :</span></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Streptococcus pneumoniae (pneumococcus).</span></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Bakteri ini yang paling umum menyebabkan meningitis pada bayi ataupun anak-anak. Jenis bakteri ini juga yang bisa menyebabkan infeksi pneumonia, telinga dan rongga hidung (sinus).</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Neisseria meningitidis (meningococcus).</span></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Bakteri ini merupakan penyebab kedua terbanyak setelah Streptococcus pneumoniae, Meningitis terjadi akibat adanya infeksi pada saluran nafas bagian atas yang kemudian bakterinya masuk kedalam peredaran darah.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Haemophilus influenzae (haemophilus).</span></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Haemophilus influenzae type b (Hib) adalah jenis bakteri yang juga dapat menyebabkan meningitis. Jenis virus ini sebagai penyebabnya infeksi pernafasan bagian atas, telinga bagian dalam dan sinusitis. Pemberian vaksin (Hib vaccine) telah membuktikan terjadinya angka penurunan pada kasus meningitis yang disebabkan bakteri jenis ini.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Listeria monocytogenes (listeria).</span></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Ini merupakan salah satu jenis bakteri yang juga bisa menyebabkan meningitis. Bakteri ini dapat ditemukan dibanyak tempat, dalam debu dan dalam makanan yang terkontaminasi. Makanan ini biasanya yang berjenis keju, hot dog dan daging sandwich yang mana bakteri ini berasal dari hewan lokal (peliharaan).</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 81pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif";">Bakteri lainnya yang juga dapat menyebabkan meningitis adalah Staphylococcus aureus dan Mycobacterium tuberculosis.</span></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.1.3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi Klinik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Pada awal penyakit, kelelahan, perubahan daya mengingat, perubahan tingkah laku</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Sesuai dengan cepatnya perjalanan penyakit pasien menjadi stupor</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Sakit kepala</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Sakit sakit pada otot</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Reaksi pupil terhadap cahaya. Photofobia apabila cahaya diarahkan pada mata pasien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Adanya disfungsi pada saraf III, IV, VI</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Pergerakan motorik pada awal penyakit biasanya normal dan pada tahap lanjutan biasa terjadi hemiparesis, hemiplagia, dan penurunan tonus otot</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Reflex brudzinski dan reflex kernig positif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Nausea<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Vomiting</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Takikardia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Kejang</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";">• Pasien merasa takut dan cemas</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.1.4<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insiden</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: 31.5pt;"><i><span style="font-family: "Times New Roman","serif";">Amerika Serikat. </span></i><span style="font-family: "Times New Roman","serif";">Insiden meningitis bervariasi sesuai dengan agent etiologi spesifik.<span> </span>Meningitis bacterial masih merupakan penyebab signifikan morbiditas dan mortalitas di seluruh dunia. Angka serangan di Amerika Serikat pertahun dilaporkan 0.6-4 kasus per 100,000 populasi. Sebelumnya, 3 kasus yang paling pathogen dengan kasus mencapai 80 %, yaitu H influenzae type B (HIB), N meningitidis, dan S pneumoniae. Lebih dari dua decade lalu, epidemologi telah mengalami perubahan secara substansial oleh karena berbagai perkembangan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: 31.5pt;"><i><span style="font-family: "Times New Roman","serif";">Internasional. </span></i><span style="font-family: "Times New Roman","serif";">Insiden meningitis diperkirakan lebih tinggi pada negara yang sedang berkembang oleh karena kurangnya akses pelayanan pencegahan seperti vaksinasi. Angka insdien 10 kali lipat lebih tinggi terjadi di negara sedang berkembang.2,3,6</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.1.5<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif";">Hidrosefalus obstruktif</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif";">MeningococcL Septicemia ( mengingocemia )</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif";">Sindrome water-friderichen (septik syok, DIC,perdarahan adrenal</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">bilateral)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif";">SIADH ( Syndrome Inappropriate Antidiuretic hormone )</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span>Efusi subdural</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif";">Kejang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif";">Edema dan herniasi serebral</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif";">Cerebral palsy</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";"><span> </span></span><span style="font-family: "Times New Roman","serif";">Gangguan mental</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 58.5pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif";">10.</span><span style="font-family: "Times New Roman","serif";">Gangguan belajar</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; text-align: justify; text-indent: 22.5pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">11.</span><span style="font-family: "Times New Roman","serif";">Attention deficit disorder</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.1.6<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Diagnostik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -31.5pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Analisis CSS dari fungsi lumbal :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Meningitis bakterial : tekanan meningkat, cairan keruh/berkabut, jumlah sel darah putih dan protein meningkat glukosa meningkat, kultur positip terhadap beberapa jenis bakteri</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Meningitis virus : tekanan bervariasi, cairan CSS biasanya jernih, sel darah putih meningkat, glukosa dan protein biasanya normal, kultur biasanya negatif, kultur virus biasanya dengan prosedur khusus</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Glukosa serum : meningkat ( meningitis )</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">LDH serum : meningkat ( meningitis bakteri )</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Sel darah putih : sedikit meningkat dengan peningkatan neutrofil ( infeksi bakteri )</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Elektrolit darah : abnormal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">ESR/LED : meningkat pada meningitis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Kultur darah/ hidung/ tenggorokan/ urine : dapat mengindikasikan daerah pusat infeksi atau mengindikasikan tipe penyebab infeksi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">MRI/ skan CT : dapat membantu dalam melokalisasi lesi, melihat ukuran/letak ventrikel; hematom daerah serebral, hemoragik atau tumor</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Ronsen dada/kepala/ sinus ; mungkin ada indikasi sumber infeksi intra cranial</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 63pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.1.7<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan/Terapi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 58.5pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terapi bertujuan memberantas penyebab infeksi disertai perawatan intensif suportif untuk membantu pasien melalui masa kritis. Sementara menunggu hasil pemeriksaan terhadap kausa diberikan obat sebagai beriku:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kombinasi ampisiin 12-18 gram, kloramfenikol 4 gram, intravena dalam dosis terbagi 4 kali per hari.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat ditambahkan campuran trimetoprim 80 mg,sulfametoksazol 400 mg intravena</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat pula ditambahkan seftriakson 4-6 gram intravena</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ASUHAN KEPERAWATAN</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.2.1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Keluhan utama</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Keluhan utama yang sering adalah panas badan tinggi, koma, kejang dan penurunan kesadaran</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Riwayat penyakit sekarang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Faktor riwayat penyakit sangat penting diketahui karena untuk mengetahui jenis kuman penyebab. Disini harus ditanya dengan jelas tetang gejala yang timbul seperti kapan mulai serangan, sembuh atau bertambah buruk. Pada pengkajian pasien meningitis biasanya didapatkan keluhan yang berhubungan dengan akibat dari infeksi dan peningkatan TIK. Keluhan tersebut diantaranya, sakit kepala dan demam adalah gejala awal yang sering. Sakit kepala berhubungan dengan meningitis yang selalu berat dan sebagai akibat iritasi meningen. Demam umumnya ada dan tetap tinggi selama perjalanan penyakit. Keluhan kejang perlu mendapat perhatian untuk dilakukan pengkajian lebih mendalam, bagaimana sifat timbulnya kejang, stimulus apa yang sering menimbulkan kejang dan tindakan apa yang telah diberikan dalam upaya menurunkan keluhan kejang tersebut.<br />
pengkajian lainnya yang perlu ditanyakan seperti riwayat selama menjalani perawatan di RS, pernahkah mengalami tindakan invasive yang memungkinkan masuknya kuman kemeningen terutama tindakan melalui pembuluh darah.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Riwayat Penyakit Dahulu</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Pengkajian penyakit yang pernah dialami pasien yang memungkinkan adanya hubungan atau menjadi predisposisi keluhan sekarang meliputi pernahkah pasien mengalami infeksi jalan napas bagian atas, otitis media, mastoiditis, tindakan bedah saraf, riwayat trauma kepala dan adanya pengaruh immunologis pada masa sebelumnya. Riwayat sakit TB paru perlu ditanyakan pada pasien terutama apabila ada keluhan batuk produktif dan pernah menjalani pengobatan obat anti TB yang sangat berguna untuk mengidentifikasi meningitis tuberculosia. Pengkajian pemakaian obat obat yang sering digunakan pasien, seperti pemakaian obat kortikostiroid, pemakaian jenis jenis antibiotic dan reaksinya (untuk menilai resistensi pemakaian antibiotic).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pengkajian psikososial</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Respon emosi pengkajian mekanisme koping yang digunakan pasien juga penting untuk menilai pasien terhadap penyakit yang dideritanya dan perubahan peran pasien dalam keluarga dan masyarakat serta respon atau pengaruhnya dalam kehidupan sehari harinya baik dalam keluarga ataupun dalam masyarakat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pemeiksaan fisik</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Aktivitas / istirahat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";">Gejala : perasaan tidak enak (malaise ), keterbatasan yang ditimbulkan kondisinya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";">Tanda : Ataksia, masalah berjalan, kelumpuhan, gerakan involunter, kelemahan secara Umum, keterbatasan dalam rentang gerak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Sirkulasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";">Gejala :adanya riwayat kardiologi, seperti endokarditis, beberapa penyakit jantung Conginetal ( abses otak ).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";">Tanda : tekanan darah meningkat, nadi menurun dan tekanan nadi berat (berhubungan Dengan peningkatan TIK dan pengaruh dari pusat vasomotor ). Takikardi, distritmia ( pada fase akut ) seperti distrimia sinus (pada meningitis )</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Eleminasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 112.5pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif";">Tanda : <span> </span>Adanya inkotinensia dan retensi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Makanan dan Cairan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -45pt;"><span style="font-family: "Times New Roman","serif";">Gejala :<span> </span>Kehilangan napsu makan, kesulitan menelan (pada periode akut )</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -45pt;"><span style="font-family: "Times New Roman","serif";">Tanda :<span> </span>Anoreksia, muntah, turgor kulit jelek, membrane mukosa kering.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Hygiene</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -45pt;"><span style="font-family: "Times New Roman","serif";">Tanda :<span> </span>Ketergantungan terhadap semua kebutuhan perawatan diri ( pada periode akut )</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Neurosensori</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";">Gejala : sakit kepala ( mungkin merupan gejala pertama dan biasanya berat ) . Pareslisia, Terasa kaku pada semua persarafan yang terkena, kehilangan sensasi ( kerusakan Pada saraf cranial ). Hiperalgesia / meningkatnya sensitifitas ( minimitis ) . Timbul Kejang ( minimitis bakteri atau abses otak ) gangguan dalam penglihatan, seperti<br />
Diplopia ( fase awal dari beberapa infeksi ). Fotopobia ( pada minimtis ). Ketulian ( pada minimitis / encephalitis ) atau mungkin hipersensitifitas terhadap kebisingan, Adanya hulusinasi penciuman / sentuhan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";">Tanda : -status mental / tingkat kesadaran ; letargi sampai kebingungan yang berat hingga Koma, delusi dan halusinasi / psikosis organic ( encephalitis ).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";"><span> </span>-Kehilangan memori, sulit mengambil keputusan ( dapat merupakan gejala Berkembangnya hidrosephalus komunikan yang mengikuti meningitis bacterial )</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";"><span> </span>-Afasia / kesulitan dalam berkomunikasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";"><span> </span>-Mata ( ukuran / reaksi pupil ) : unisokor atau tidak berespon terhadap cahaya ( peningkatan TIK ), nistagmus ( bola mata bergerak terus menerus ).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">-Ptosis ( kelopak mata atas jatuh ) . Karakteristik fasial (wajah) perubahan pada Fungsi motorik dan sensorik ( saraf cranial V dan VII terkena )</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";"><span> </span><span> </span><span> </span>-Kejang umum atau lokal ( pada abses otak ) . Kejang lobus temporal . Otot Mengalami hipotonia /flaksid paralisis ( pada fase akut meningitis ). Spastik ( encephalitis).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";"><span> </span><span> </span>-Hemiparese hemiplegic ( meningitis / encephalitis )</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -9pt;"><span style="font-family: "Times New Roman","serif";"><span> </span><span> </span>-Tanda brudzinski positif dan atau tanda kernig positif merupakan indikasi adanya Iritasi meningeal ( fase akut)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";"><span> </span><span> </span><span> </span>-Regiditas muka ( iritasi meningeal )</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";"><span> </span><span> </span><span> </span>-Refleks tendon dalam terganggu, brudzinski positif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif";"><span> </span><span> </span><span> </span><span> </span>- Refleks abdominal menurun</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Nyeri / Kenyamanan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif";">Gejala : sakit kepala ( berdenyut dengan hebat, frontal ) mungkin akan diperburuk oleh Ketegangan leher /punggung kaku ,nyeri pada gerakan ocular, tenggorokan nyeri</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif";">Tanda : Tampak terus terjaga, perilaku distraksi /gelisah menangis / <span> </span>mengeluh</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pernapasan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 126pt; text-align: justify; text-indent: -45pt;"><span style="font-family: "Times New Roman","serif";">Gejala : Adanya riwayat infeksi sinus atau paru Tanda : Peningkatan kerja pernapasan (tahap awal ), perubahan mental ( letargi sampai Koma ) dan gelisah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Keamanan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify; text-indent: -40.5pt;"><span style="font-family: "Times New Roman","serif";">Gejala : - Adanya riwayat infeksi saluran napas atas atau infeksi lain, meliputi mastoiditis Telinga tengah sinus, abses gigi, abdomen atau kulit, fungsi lumbal, pembedahan, Fraktur pada tengkorak / cedera kepala.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 117pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">-Imunisasi yang baru saja berlangsung ; terpajan pada meningitis, terpajan oleh Campak, herpes simplek, gigitan binatang, benda asing yang terbawa.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif";">-Gangguan penglihatan atau pendengaran</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 76.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Tanda :<span> </span>- suhu badan meningkat,diaphoresis, menggigil</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 9pt;"><span style="font-family: "Times New Roman","serif";">-Kelemahan secara umum ; tonus otot flaksid atau plastic<br />
<span> </span>- Gangguan sensoris</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.2.2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Diagnosa keperawatannya yaitu :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Resiko tinggi terhadap (penyebaran) infeksi berhubungan dengan statis cairan tubuh</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Perubahan perfusi jaringan serebral berhubungan dengan edema serebral yang mengubah / menghentikan aliran darah arteri / vena</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Resiko tinggi terhadap trauma berhubungan dengan kelemahan umum</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Nyeri ( akut ) berhubungan dengan adanya proses inflamasi / infeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Ansietas / ketakutan berhubungan dengan pemisahan dari system pendukung ( hospitalisasi ).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.2.3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana Keperawatan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Resiko tinggi terhadap ( penyebaran ) infeksi berhubungan dengan statis cairan tubuh. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Hasil yang diharapkan / criteria evaluasi pasien anak ; mencapai masa penyembuhan tepat waktu, tanpa penyebaran infeksi endogen atau keterlibatan orang lain</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pertahankan teknik aseptik dan cuci tangan baik pasien, pengunjung, maupun staf.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional ; menurunkan resiko pasien terkena infeksi sekunder. Mengontrol penyebaran sumber infeksi, mencegah pemajanan pada individu terinfeksi ( mis : individu yang mengalami infeksi saluran napas atas )</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pantau dan catat secara teratur tanda-tanda klinis dari proses infeksi.<br />
Rasional : Terapi obat akan diberikan terus menerus selama lebih 5 hari setelah suhu turun ( kembali normal ) dan tanda-tanda klinisnya jelas. Timbulnya tanda klinis terus menerus merupakan indikasi perkembangan dari meningokosemia akut yang dapat bertahan sampai berminggu minggu / berbulan bulan atau penyebaran pathogen secara hematogen / sepsis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Ubah posisi pasien dengan teratur tiap 2 jam.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasionalisasi ; Mobilisasi secret dan meningkatkan kelancaran secret yang akan menurunkan resiko terjadinya komplikasi terhadap pernapasan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Catat karakteristik urine, seperti warna, kejernihan dan bau</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasionalisasi ; Urine statis, dehidrasi dan kelemahan umum meningkatkan resiko terhadap infeksi kandung kemih / ginjal / awitan sepsis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Kolaborasi tim medis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 85.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : Obat yang dipilih tergantung pada infeksi dan sensitifitas individu. Catatan ; obat cranial mungkin diindikasikan untuk basilus gram negative, jamur, amoeba</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Perubahan perfusi jaringan serebral berhubungan dengan edema serebral yang mengubah / menghentikan aliran darah arteri / vena. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Hasil yang diharapkan / kriteria pasien anak : mempertahankan tingkat kesadaran , mendemontrasikan tanda-tanda vital stabil, melaporkan tak adanya / menurunkan berat sakit kepala, mendemontrasikan adanya perbaikan kognitif dan tanda peningkatan TIK.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Perubahan tirah baring dengan posisi kepala datar dan pantau tanda vital sesuai indikasi setelah dilakukan fungsi lumbal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : perubahan tekanan CSS mungkin merupakan adanya resiko herniasis batang otak yang memerlukan tindakan medis dengan segera.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pantau / catat status neurologis dengan teratur dan bandingkan dengan keadaan normalnya, seperti GCS.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : pengkajian kecenderungan adanya perubahan tingkat kesadaran dan potensial peningkatan TIK adalah sangat berguna dalam menntukan lokasi, penyebaran / luas dan perkembangan dari kerusakan serebral.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pantau masukan dan keluaran . catat karakteristik urine, turgor kulit, dan keadaan membrane mukosa.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : hipertermia meningkatkan kehilangan air tak kasat mata dan meningkatkan resiko dehidrasi, terutama jika tingkat kesadaran menurun / munculnya mual menurunkan pemasukan melalui oral.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Berikantindakan yang memberikan rasa nyaman seperti massage punggung, lingkungan yang tenang, suara yang halus dan sentuhan yang lembut.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : meningkatkan istirahat dan menurunkan stimulasi sensori yang berlebihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pantau gas darah arteri. Berikan terapi oksigen sesuai kebutuhan.<br />
Rasional : terjadinya asidosis dapat menghambat masuknya oksigen</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">pada tingkat sel yang memperburuk / meningkatkan iskemia serebral.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Berikan obat sesuai indikasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Resiko tinggi terhadap trauma berhubungan dengan kelemahan umum.<br />
Hasil yang diharapkan / kriteria evaluasi pasien anak : tidak mengalami kejang atau penyerta atau cedera lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 67.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pantau adanya kejang / kedutan pada tangan, kaki dan mulut atau otot wajah yang lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : mencerminkan pada iritasi SSP secara umum yang memerlukan evaluasi segera dan intervensi yang mungkin untuk mencegah komplikasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Berikan keamanan pada pasien dengan memberi bantuan pada penghalang tempat tidur dan pertahankan tetap terpasang dan pasang jalan napas buatan plastik atau gulungan lunak dan alat penghisap.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : melindungi pasien jika kejang. Catatan ; masukan jalan napas bantuan / gulungan lunak jika hanya rahangnya relaksasi, jangan dipaksa memasukkan ketika giginya mengatup dan jaringan lunak akan rusak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pertahankan tirah baring selama fase akut. Pindahkan .gerakkan dengan bantuan sesuai membaiknya keadaan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : menurunkan resiko terjatuh / trauma jika terjadi vertigo, sinkope atau ataksia.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Berikan obat sesuai indikasi seperti fenitoin ( dilantin ), diazepam , fenobarbital.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : merupakan indikasi untuk penanganan dan pencegahan kejang .catatan : fenobarbital dapat menyebabkan defresi pernapasan dan sedative serta menutupi tanda / gejala dari peningkatan TIK.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 67.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Nyeri ( akut ) berhubungan dengan adanya proses inflamasi / infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 67.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Hasil yang diharapkan / kriteria evaluasi pasien anak : melaporkan nyeri hilang / terkontrol, menunjukkan poster rileks dan mampu tidur / istirahat dengan tepat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 67.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Kaji skala nyeri</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : Untuk mengetahui tingkat nyeri klien</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Berikan lingkungan yang tenang, ruangan agak gelap sesuai indikasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : menurunkan reaksi terhadap stimulasi dari luar atau sensitifitas pada cahaya dan meningkatkan istirahat / relaksasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Tingkatkan tirah baring, bantulah kebutuhan perawatan yang penting .</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : menurunkan gerakan yang dapat meningkatkan nyeri.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Berikan latihan rentang gerak aktif / pasif secara aktif dan massage otot daerah leher /bahu. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : dapat membantu merelaksasikan ketegangan otot yang menimbulkan reduksi nyeri atau rasa tidak nyaman tersebut.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Berikan analgetik, seperti asetaminofen dan kodein</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : mungkin diperlukan untuk menghilangkan nyeri yang berat. Catatan : narkotik merupakan kontraindikasi sehingga menimbulkanb ketidak akuratan dalam pemeriksaan neurologis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 67.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Ansietas / ketakutan berhubungan dengan pemisahan dari system pendukung ( hospitalisasi ).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 67.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Hasil yang diharapkan / criteria evaluasi pasien anak : mengikuti dan mendiskusikan rasa takut, mengungkapkan kekurang pengetahuan tentang situasi, tampak rileks dan melaporkan ansietas berkurang sampai pada tingkat dapat diatasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 67.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Kaji status mental dan tingkat ansietas dari pasien / keluarga. Catat adanya tanda-tanda verbal atau non verbal.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : gangguan tingkat kesadaran dapat mempengaruhi ekspresi rasa takut tetapi tidak menyangkal keberadaannya. Derajat ansietas akan dipengaruhi bagaimana informasi tersebut diterima oleh individu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Berikan penjelasan hubungan antara proses penyakit dan gejala.<br />
Rasional : meningkatkan pemahaman, mengurangi rasa takut karena ketidaktahuan dan dapat membantu dan menurunkan ansietas.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Jawab setiap pertanyaan dengan penuh perhatian dan berikan informasi tentang prognosa penyakit.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : penting untuk menciptakan kepercayan karena diagnosa meningitis mungkin menakutkan, ketulusan dan informasi yang akurat dapat memberikan keyakinan pada pasien dan juga keluarga</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Libatkan pasien / keluarga dalam perawatan, perencanaan kehidupan sehari-hari, membuat keputusan sebanyak mungkin.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : meningkatkan perasaan kontrol terhadap diri dan meningkatkan kemandirian.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Lindungi privasi pasien jika terjadi kejang.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: yellow; line-height: 150%; margin-left: 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional : memperhatikan kebutuhan privasi pasien memberikan peningkatan akan harga diri pasien dan melindungi pasien dri rasa malu.</span></div><div class="MsoListParagraphCxSpLast" style="color: yellow; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.2.4<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi</span></div><div class="MsoNormal" style="color: yellow; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil yang diharapkan :</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Mencapai masa penyembuhan tepat waktu, tanpa bukti penyebaran infeksi endogen atau keterlibatan orang lain.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Mempertahankan tingkat kesadaran biasanya/membaik dan fungsi motorik/sensorik, mendemonstrasikan tanda-tanda vital stabil.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Tidak mengalami kejang/penyerta atau cedera lain.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Melaporkan nyeri hilang/terkontrol dan menunjukkan postur rileks dan mampu tidur/istirahat dengan tepat.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Tampak rileks dan melaporkan ansietas berkurang dan mengungkapkan keakuratan pengetahuan tentang situasi</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";"><br />
</span></div><div align="center" class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">PENUTUP</span></b></div><div align="center" class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: center;"><br />
</div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesimpulan</span></div><div class="MsoNormal" style="color: yellow; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Meningitis yaitu infeksi cairan otak disertai radang yang mengenai piamater,araknoid dan dalam derajat yang lebih ringan mengenai jaringan otak dan medulla spinalis yang superficial.(neorologi kapita selekta,1996) dimana<span> </span><span class="fullpost">Meningitis yang disebabkan oleh virus umumnya tidak berbahaya, akan pulih tanpa pengobatan dan perawatan yang spesifik. Namun Meningitis disebabkan oleh bakteri bisa mengakibatkan kondisi serius, misalnya kerusakan otak, hilangnya pendengaran, kurangnya kemampuan belajar, bahkan bisa menyebabkan kematian. Dengan diagnose keperawatan yang dapat diambil yaitu </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi terhadap (penyebaran) infeksi berhubungan dengan statis cairan tubuh, </span><span style="font-family: "Times New Roman","serif";">Perubahan perfusi jaringan serebral berhubungan dengan edema serebral yang mengubah / menghentikan aliran darah arteri / vena, Resiko tinggi terhadap trauma berhubungan dengan kelemahan umum, Nyeri ( akut ) berhubungan dengan adanya proses inflamasi / infeksi, Ansietas / ketakutan berhubungan dengan pemisahan dari system pendukung ( hospitalisasi ).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saran</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Bagi perawat diharapkan dapat melaksanakan asuhan keperawatan sesuai dengan prosedur yang ada dan bagi seluruh masyarakat agar dapat selalu menjaga kondisi tubuhnya agar terhindar dari penyebaran mikroorganisme.</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 36pt;"><br />
</div><div align="center" class="MsoNormal" style="color: yellow; line-height: 150%; text-align: center;"><span style="font-family: "Times New Roman","serif";">DAFTAR PUSTAKA</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -45pt;"><cite>augusfarly.wordpress.com (diakses 29 juli 2010)</cite></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -45pt;"><cite><span style="font-size: 12pt; font-style: normal; line-height: 150%;">Betz, Linda. 2009</span></cite><cite><span style="font-size: 12pt; line-height: 150%;">. Buku Saku Keperawatan Pediatri. </span></cite><cite><span style="font-size: 12pt; font-style: normal; line-height: 150%;">Edisi 5. Jakarta : EGC</span></cite></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -45pt;"><span style="font-family: "Times New Roman","serif";">Doenges, Marilyn E, dkk.(1999).<em>Rencana Asuhan Keperawatan : Pedoman untuk Perencanaan dan Pendokumentasian Perawatan Pasien</em>. Alih Bahasa, I Made Kariasa, N Made Sumarwati. Editor edisi bahasa Indonesia, Monica Ester, Yasmin asih. Ed.3. Jakarta : EGC<cite><span style="font-style: normal;"></span></cite></span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -45pt;"><cite>informasi-kesehatan40.blogspot.com (29 JUNI 2008)</cite><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 40.5pt; text-align: justify; text-indent: -40.5pt;"><cite><span style="font-size: 12pt; font-style: normal; line-height: 150%;">Mansjuer, arif, dkk. 2000. Kapita Selekta Kedokteran. Edisi Ketiga. Jilid 2. Jakarta : Media Aesculapius </span></cite><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Nelson. 1992. <i>Ilmu Kesehatan Anak</i>. Jakarta : EGC</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Ngastiah. 1997. <i>Perawatan Anak Sakit</i>. Jakarta : EGC</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Speer, Kathleen. 2007. Rencana Asuhan Keperawatan Pediatrik Dengan Clinical Pathways. Edisi 3. Jakarta : EGC</span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -42.55pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suriadi, Yuliani, rita. 2006. <i>Asuhan Keperawatan Pada Anak</i>. Edisi 2. Jakarta : Penebar Swadaya.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNoSpacing" style="color: yellow; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Wong, Donna. L. 2003. <i>Pedoman Klinis Keperawatan Pediatri</i>k. Jakarta : EGC</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-6306127886588713452011-02-21T03:34:00.000-08:002011-02-21T03:35:49.450-08:00Askep Skoliosis<div style="color: lime;"><m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN</span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Skoliosis adalah kelengkungan tulang belakang yang abnormal ke arah samping, yang dapat terjadi pada segmen servikal (leher), torakal (dada) maupun lumbal (pinggang).Skolisis merupakan penyakit tulang belakang yang menjadi bengkok ke samping kiri atau kanan sehingga wujudnya merupakan bengkok benjolan yang dapat dilihat dengan jelas dari arah belakang.Penyakit ini juga sulit untuk dikenali kecuali setelah penderita meningkat menjadi dewasa <b>(Mion, Rosmawati, 2007).</b></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Walaupun penyebab skoliosis idiopatik tidak diketahui, namun ada beberapa perbedaan teori yang menunjukkan penyebabnya seperti faktor genetik, hormonal, abnormalitas pertumbuhan, gangguan biomekanik dan neuromuskular tulang, otot dan jaringan fibrosa.Meskipun skoliosis tidakmendatangkan rasa sakit penderita perlu di rawat seawal mungkin.Tanpa perawatan, tulang belakang menjadi semakin bengkak dan menimbulkan berbagai komplikasi seperti kerusakan peru-paru dan jantung, serta sakit tulang belakang.</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Sekitar 4% dari seluruh anak-anak yang berumur 10-14 tahun mengalami skoliosis; 40-60% diantaranya ditemukan pada anak perempuan.Scoliosis adalah kira-kira dua kali lebih umum pada anak-anak perempuan daripada anak-anak lelaki.Ia dapat dilihat pada semua umur, namun ia adalah lebih umum pada mereka yang lebih dari 10 tahun umurnya. </span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Sekitar 80% skoliosis adalah idiopatik, Skoliosis idiopatik dengan kurva lebih dari 100 dilaporkan dengan prevalensi 0,5-3 per 100 anak dan remaja. Prevalensi dilaporkan pada kurva lebih dari 300 yaitu 1,5-3 per 1000 penduduk. Insiden yang terjadi pada skoliosis idiopatik infantil bervariasi, namun dilaporkan paling banyak dijumpai di Eropa daripada Amerika Utara, dan lebih banyak laki-laki dari pada perempuan.</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Scoliosis adalah turunan atau warisan dimana orang-orang dengan scoliosis adalah lebih mungkin mempunyai anak-anak dengan scoliosis.</span></div><b style="color: lime;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></b><br style="color: lime;" /> <div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMBAHASAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGERTIAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis adalah suatu kelainan bentuk pada tulang belakang dimana terjadi pembengkokan tulang belakang ke arah samping kiri atau kanan.Kelainan skoliosis ini sepintas terlihat sangat sederhana.Namun apabila diamati lebih jauh sesungguhnya terjadi perubahan yang luar biasa pada tulang belakang akibat perubahan bentuk tulang belakang secara tiga dimensi, yaitu perubahan sturktur penyokong tulang belakang seperti jaringan lunak sekitarnya dan struktur lainnya <b>(Rahayussalim, 2007</b>).Skoliosis ini biasanya membentuk kurva “C” atau kurva “S”.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis berasal dari kata Yunani yang berarti lengkungan, mengandung arti kondisi patologik.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis merupakan masalah ortopedik yang sering terjadi adalah pelengkungan lateral dari medulla spinalis yang dapat terjadi di sepanjang spinal tersebut. Pelengkungan pada area toraks merupakan scoliosis yang paling sering terjadi, meskipun pelengkungan pada area servikal dan area lumbal adalah scoliosis yang paling parah.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesimpulan,</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> skoliosis mengandung arti kondisi patologik yaitu kelengkungan tulang belakang yang abnormal ke arah samping (kiri atau kanan ).</span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ETIOLOGI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebab terjadinya skoliosis belum diketahui secara pasti, tapi dapat diduga dipengaruhi oleh diantaranya kondisi osteopatik, seperti fraktur, penyakit tulang, penyakit arthritis, dan infeksi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Scoliosis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> tidak hanya disebabkan oleh sikap duduk yang salah.. </span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut penelitian di Amerika Serikat, memanggul beban yang berat seperti tas punggung, bisa menjadi salah satu pemicu <i>scoliosis</i>.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat 3 penyebab umum dari skoliosis:</span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kongenital (bawaan), biasanya berhubungan dengan suatu kelainan dalam pembentukan tulang belakang atau tulang rusuk yang menyatu</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Neuromuskuler, pengendalian otot yang buruk atau kelemahan otot atau kelumpuhan akibat penyakit berikut :Cerebral palsy, Distrofi otot, Polio, Osteoporosis juvenile</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Idiopatik, penyebabnya tidak diketahui. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PATOFISIOLOGI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan bentuk tulang punggung yang disebut scoliosis ini berawal dari adanya syaraf – syaraf yang lemah atau bahkan lumpuh yang menarik ruas – ruas tulang belakang.Tarikan ini berfungsi untuk menjaga ruas tulang belakang berada pada garis yang normal yang bentuk nya seperti penggaris atau lurus.Tetapi karena suatu hal, diantaranya kebiasaan duduk yang miring, membuat sebagian syaraf yang bekerja menjadi lemah. Bila ini terus berulang menjadi kebiasaan, maka syaraf itu bahkan akan mati. Ini berakibat pada ketidakseimbangan tarikan pada ruas tulang belakang.Oleh karena itu, tulang belakang yang menderita skoliosis itu bengkok atau seperti huruf S atau pun huruf C.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KLASIFIKASI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis dibagi dalam dua jenis yaitu struktural dan bukan struktural.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis struktural </span></span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis tipe ini bersifat irreversibel ( tidak dapat di perbaiki ) dan dengan rotasi dari tulang punggung Komponen penting dari deformitas itu adalah rotasi vertebra, processus spinosus memutar kearah konkavitas kurva.</span></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tiga bentuk skosiliosis struktural yaitu :</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Skosiliosis Idiopatik. adalah bentuk yang paling umum terjadi dan diklasifikasikan menjadi 3 kelompok :</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infantile : dari lahir-3 tahun.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak-anak : 3 tahun – 10 tahun </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Remaja : Muncul setelah usia 10 tahun ( usia yangpaling umum )</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis Kongenital adalah skoliosis yang menyebabkan malformasi satu atau lebih badan vertebra.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis Neuromuskuler, anak yang menderita penyakit neuromuskuler (seperti paralisis otak, spina bifida, atau distrofi muskuler) yang secara langsung menyebabkan deformitas.</span></span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis nonstruktural ( Postural )</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Skoliosis tipe ini bersifat reversibel (dapat dikembalikan ke bentuk semula), dan tanpa perputaran (rotasi) dari tulang punggung..Pada skoliosis postural, deformitas bersifat sekunder atau sebagai kompensasi terhadap beberapa keadaan diluar tulang belakang, misalnya dengan kaki yang pendek, atau kemiringan pelvis akibat kontraktur pinggul, bila pasien duduk atau dalam keadaan fleksi maka kurva tersebut menghilang.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada tiga tipe-tipe utama lain dari scoliosis :</span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -63.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Functional: Pada tipe scoliosis ini, spine adalah normal, namun suatu lekukan abnormal berkembang karena suatu persoalan ditempat lain didalam tubuh. Ini dapat disebabkan oleh satu kaki adalah lebih pendek daripada yang lainnya atau oleh kekejangan-kekejangan di punggung.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -63.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Neuromuscular: Pada tipe scoliosis ini, ada suatu persoalan ketika tulang-tulang dari spine terbentuk. Baik tulang-tulang dari spine gagal untuk membentuk sepenuhnya, atau mereka gagal untuk berpisah satu dari lainnya.Tipe scoliosis ini berkembang pada orang-orang dengan kelainn-kelainan lain termasuk kerusakan-kerusakan kelahiran, penyakit otot (muscular dystrophy), cerebral palsy, atau penyakit Marfan. Jika lekukan hadir waktu dilahirkan, ia disebut congenital. Tipe scoliosis ini seringkali adalah jauh lebih parah dan memerlukan perawatan yang lebih agresif daripada bentuk-bentuk lain dari scoliosis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -63.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Degenerative: Tidak seperti bentuk-bentuk lain dari scoliosis yang ditemukan pada anak-anak dan remaja-remaja, degenerative scoliosis terjadi pada dewasa-dewasa yang lebih tua. Ia disebabkan oleh perubahan-perubahan pada spine yang disebabkan oleh arthritis. Pelemahan dari ligamen-ligamen dan jaringan-jaringan lunak lain yang normal dari spine digabungkan dengan spur-spur tulang yang abnormal dapat menjurus pada suatu lekukan dari spine yang abnormal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -63.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lain-Lain: Ada penyebab-penyebab potensial lain dari scoliosis, termasuk tumor-tumor spine seperti osteoid osteoma. Ini adalah tumor jinak yang dapat terjadi pada spine dan menyebabkan nyeri/sakit.Nyeri menyebabkan orang-orang untuk bersandar pada sisi yang berlawanan untuk mengurangi jumlah dari tekanan yang diterapkan pada tumor.Ini dapat menjurus pada suatu kelainan bentuk spine.</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">MANIFESTASI KLINIK </span></b></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala yang ditimbulkan berupa: </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang belakang melengkung secara abnormal ke arah samping</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bahu dan atau pinggul kiri dan kanan tidak sama tingginya </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri punggung </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelelahan pada tulang belakang setelah duduk atau berdiri lama </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis yang berat (dengan kelengkungan yang lebih besar dari 60 ) bisa menyebabkan gangguan pernafasan.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kebanyakan pada punggung bagian atas, tulang belakang membengkok ke kanan dan pada punggung bagian bawah, tulang belakang membengkok ke kiri; sehingga bahu kanan lebih tinggi dari bahu kiri.Pinggul kanan juga mungkin lebih tinggi dari pinggul kiri.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Awalnya penderita mungkin tidak menyadari atau merasakan sakit pada tubuhnya karena memang skoliosis tidak selalu memberikan gejala–gejala yang mudah dikenali.Jika ada pun, gejala tersebut tidak terlalu dianggap serius karena kebanyakan mereka hanya merasakan pegal–pegal di daerah punggung dan pinggang mereka saja.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Dr Siow dalam artikel yang ditulis oleh Norlaila H. Jamaluddin (Jamaluddin, 2007), skoliosis tidak menunjukkan gejala awal.Kesannya hanya dapat dilihat apabila tulang belakang mulai bengkok.Jika keadaan bertambah buruk, skoliosis menyebabkan tulang rusuk tertonjol keluar dan penderita mungkin mengalami masalah sakit belakang serta sukar bernafas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dalam kebanyakan kondisi, skoliosis hanya diberi perhatian apabila penderita mulai menitik beratkan soal penampilan diri.Walaupun skoliosis tidak mendatangkan rasa sakit, rata-rata penderita merasa malu dan rendah diri.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis pada masyarakat indonesia dapat dijumpai mulai dari derajat yang sangat ringan sampai pada derajat yang sangat berat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Derajat pembengkokan biasanya diukur dengan cara Cobb dan disebut sudut Cobb. Dari besarnya sudut skoliosis dapat dibagi menjadi (Kawiyana dalam Soetjiningsih, 2004) :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis ringan : sudut Cobb kurang dari 20”</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis sedang : sudut Cobb antara 21 – 40”</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis berat : sudut Cobb lebih dari 41”</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada skoliosis derajat berat (lebih dari 40 derajat), hanya dapat diluruskan melalui operasi.</span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PROGNOSIS</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prognosis tergantung kepada penyebab, lokasi dan beratnya kelengkungan.Semakin besar kelengkungan skoliosis, semakin tinggi resiko terjadinya progresivitas sesudah masa pertumbuhan anak berlalu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis ringan yang hanya diatasi dengan brace memiliki prognosis yang baik dan cenderung tidak menimbulkan masalah jangka panjang selain kemungkinan timbulnya sakit punggung pada saat usia penderita semakin bertambah.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penderita skoliosis idiopatik yang menjalani pembedahan juga memiliki prognosis yang baik dan bisa hidup secara aktif dan sehat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penderita skoliosis neuromuskuler selalu memiliki penyakit lainnya yang serius (misalnya cerebral palsy atau distrofi otot).Karena itu tujuan dari pembedahan biasanya adalah memungkinkan anak bisa duduk tegak pada kursi roda.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi yang menderita skoliosis kongenital memiliki sejumlah kelainan bentuk yang mendasarinya, sehingga penanganannyapun tidak mudah dan perlu dilakukan beberapa kali pembedahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KOMPLIKASI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Walaupun skoliosis tidak mendatangkan rasa sakit, penderita perlu dirawat seawal mungkin. Tanpa perawatan, tulang belakang menjadi semakin bengkok dan menimbulkan berbagai komplikasi seperti :</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan paru-paru dan jantung.</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ini boleh berlaku jika tulang belakang membengkok melebihi 60 derajat. Tulang rusuk akan menekan paru-paru dan jantung, menyebabkan penderita sukar bernafas dan cepat capai. Justru, jantung juga akan mengalami kesukaran memompa darah. Dalam keadaan ini, penderita lebih mudah mengalami penyakit paru-paru dan pneumonia.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sakit tulang belakang.</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Semua penderita, baik dewasa atau kanak-kanak, berisiko tinggi mengalami masalah sakit tulang belakang kronik. Jika tidak dirawat, penderita mungkin akan menghidap masalah sakit sendi. Tulang belakang juga mengalami lebih banyak masalah apabila penderita berumur 50 atau 60 tahun.</span></span><a href="http://www.blogger.com/post-edit.g?blogID=2695819362399801347&postID=630612788658871345" name="_GoBack"></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMERIKSAAN PENUNJANG</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pemeriksaan fisik penderita biasanya diminta untuk membungkuk ke depan sehingga pemeriksa dapat menentukan kelengkungan yang terjadi. Pemeriksaan neurologis (saraf) dilakukan untuk menilai kekuatan, sensasi atau refleks.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan lainnya yang biasa dilakukan:</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliometer adalah</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> sebuah alat untuk mengukur sudut kurvaturai.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span class="fullpost">Cara pengukuran dengan skoliometer dilakukan pada pasien dengan posisi membungkuk, kemudian atur posisi pasien karena posisi ini akan berubah-ubah tergantung pada lokasi kurvatura, sebagai contoh kurva dibawah vertebra lumbal akan membutuhkan posisi membungkuk lebih jauh dibanding kurva pada thorakal. </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemudian letakkan skoliometer pada apeks kurva, biarkan skoliometer tanpa ditekan, kemudian baca angka derajat kurva.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada screening, pengukuran ini signifikan apabila hasil yang diperoleh lebih besar dari 50, hal ini biasanya menunjukkan derajat kurvatura > 200 pada pengukuran cobb’s angle pada radiologi sehingga memerlukan evaluasi yang lanjut</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rontgen tulang belakang</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Foto polos : Harus diambil dengan posterior dan lateral penuh terhadap tulang belakang dan krista iliaka dengan posisi tegak, untuk menilai derajat kurva dengan metode Cobb dan menilai maturitas skeletal dengan metode Risser. Kurva structural akan memperlihatkan rotasi vertebra, pada proyeksi posterior-anterior, vertebra yang mengarah ke puncak prosessus spinosus menyimpang kegaris tengah; ujung atas dan bawah kurva diidentifikasi sewaktu tingkat simetri vertebra diperoleh kembali.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cobb Angle diukur</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dengan menggambar garis tegak lurus dari batas superior dari vertebra paling atas pada lengkungan dan garis tegak lurus dari akhir inferior vertebra paling bawah.Perpotongan kedua garis ini membentuk suatu sudut yang diukur.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Maturitas kerangka dinilai dengan beberapa cara, hal ini penting karena kurva sering bertambah selama periode pertumbuhan dan pematangan kerangka yang cepat. Apofisis iliaka mulai mengalami penulangan segera setelah pubertas; ossifikasi meluas kemedial dan jika penulangan krista iliaka selesai, pertambahan skoliosis hanya minimal. Menentukan maturitas skeletal melalui tanda Risser, dimana ossifikasi pada apofisis iliaka dimulai dari Spina iliaka anterior superior (SIAS) ke posteriormedial.Tepi iliaka dibagi kedalam 4 kuadran dan ditentukan kedalam grade 0 sampai 5. Derajat Risser adalah sebagai berikut :</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Grade 0 : tidak ada ossifikasi, </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">grade 1 : penulangan mencapai 25%, </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">grade 2 : penulangan mencapai 26-50%, </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">grade 3 : penulangan mencapai 51-75%, </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">grade 4 : penulangan mencapai 76% </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">grade 5 : menunjukkan fusi tulang yang komplit.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">MRI ( jika di temukan kelainan saraf atau kelainan pada rontgen )</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENATALAKSANAAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan dilakukannya tatalaksana pada skoliosis meliputi 4 hal penting :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencegah progresifitas dan mempertahankan keseimbangan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan fungsi respirasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengurangi nyeri dan memperbaiki status neurologis</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kosmetik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun pilihan terapi yang dapat dipilih, dikenal sebagai <b>“The three O’s” adalah :</b></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemantauan dilakukan jika derajat skoliosis tidak begitu berat, yaitu <25o pada tulang yang masih tumbuh atau <50o pada tulang yang sudah berhenti pertumbuhannya. Rata-rata tulang berhenti tumbuh pada saar usia 19 tahun. Pada pemantauan ini, dilakukan kontrol foto polos tulang punggung pada waktu-waktu tertentu.Foto kontrol pertama dilakukan 3 bulan setelah kunjungan pertama ke dokter.Lalu sekitar 6-9 bulan berikutnya bagi yang derajat <20>20.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Orthosis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Orthosis dalam hal ini adalah pemakaian alat penyangga yang dikenal dengan nama brace. Biasanya indikasi pemakaian alat ini adalah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada kunjungan pertama, ditemukan derajat pembengkokan sekitar 30-40 derajat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat progresifitas peningkatan derajat sebanyak 25 derajat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis dari alat orthosis ini antara lain :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Milwaukee</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Boston</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Charleston bending brace</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alat ini dapat memberikan hasil yang cukup signifikan jika digunakan secara teratur 23 jamdalam sehari hingga 2 tahun setelah menarche.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Operasi </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak semua skoliosis dilakukan operasi. Indikasi dilakukannya operasi pada skoliosis adalah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat derajat pembengkokan >50 derajat pada orang dewasa</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat progresifitas peningkatan derajat pembengkokan >40-45 derajat pada anak yang</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sedang tumbuh</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat kegagalan setelah dilakukan pemakaian alat orthosis</span></div><b style="color: lime;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><br clear="all" style="page-break-before: always;" /> </span></b> <div class="MsoNormal" style="color: lime;"><br />
</div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENUTUP</span></b></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 21.3pt;"><br />
</div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Scoliosis adalah suatu kelainan yang menyebabkan suatu lekukan yang abnormal dari spine (tulang belakang).</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis dibagi menjadi :</span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Functional: Pada tipe scoliosis ini, spine adalah normal, namun suatu lekukan abnormal berkembang karena suatu persoalan ditempat lain didalam tubuh.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Neuromuscular: Pada tipe scoliosis ini, ada suatu persoalan ketika tulang-tulang dari spine terbentuk. Baik tulang-tulang dari spine gagal untuk membentuk sepenuhnya, atau mereka gagal untuk berpisah satu dari lainnya.</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Degenerative: Pelemahan dari ligamen-ligamen dan jaringan-jaringan lunak lain yang normal dari spine digabungkan dengan spur-spur tulang yang abnormal dapat menjurus pada suatu lekukan dari spine yang abnormal.</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi dari skoliosis adalah :</span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kongenital (bawaan), biasanya berhubungan dengan suatu kelainan dalam pembentukan tulang belakang atau tulang rusuk yang menyatu</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Neuromuskuler, pengendalian otot yang buruk atau kelemahan otot atau kelumpuhan akibat penyakit</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Idiopatik, penyebabnya tidak diketahui.</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan pada pasien dengan skoliosis : The three O’s</span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Orthosis</span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Operasi</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ASUHAN KEPERAWATAN</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan fisik meliputi :</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengkaji skelet tubuh</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya deformitas dan kesejajaran.Pertumbuhan tulang yang abnormal akibat tumor tulang.Pemendekan ekstremitas, amputasi dan bagian tubuh yang tidak dalam kesejajaran anatomis.Angulasi abnormal pada tulang panjang atau gerakan pada titik selain sendi biasanya menandakan adanya patah tulang.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengkaji tulang belakang</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skoliosis (deviasi kurvatura lateral tulang belakang)</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengkaji sistem persendian</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Luas gerakan dievaluasi baik aktif maupun pasif, deformitas, stabilitas, dan adanya benjolan, adanya kekakuan sendi </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengkaji system otot</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemampuan mengubah posisi, kekuatan otot dan koordinasi, dan ukuran masing-masing otot.Lingkar ekstremitas untuk mementau adanya edema atau atropfi, nyeri otot.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengkaji cara berjalan</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya gerakan yang tidak teratur dianggap tidak normal. Bila salah satu ekstremitas lebih pendek dari yang lain. Berbagai kondisi neurologist yang berhubungan dengan caraberjalan abnormal (mis.cara berjalan spastic hemiparesis - stroke, cara berjalan selangkah-selangkah – penyakit lower motor neuron, cara berjalan bergetar – penyakit Parkinson).</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengkaji kulit dan sirkulasi perifer</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Palpasi kulit dapat menunjukkan adanya suhu yanglebih panas atau lebih dingin dari lainnya dan adanyaedema.Sirkulasi perifer dievaluasi dengan mengkaji denyut perifer, warna, suhu dan waktu pengisian kapiler.</span></span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Analisa data</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DS</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien mengetakan nyeri punggung</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien mengatakan kelelahan di tulang belakang setelah duduk atau berdiri lama</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien mengatakan kesusahan bernafas</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DO:</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bahu yang tampak tidak sama tinggi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tampak tonjolan skapula yang tidak sama</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tampak pinggul yang tidak sama</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ketidakefektifan pola nafas berhubungan dengan penekanan nyeri</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri punggung berhubungan dengan posisi tubuh miring ke lateral</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan mobilitas fisik berhubungan dengan postur tubuh yang tidak seimbang</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan citra tubuh atau konsep diri yang berhubungan dengan postur tubuh miring kelateral.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana keperawatan</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ketidakefektifan pola nafas berhubungan dengan penekanan paru </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Pola nafas efektif </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana tindakan :</span></b></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji status pernafasan setiap 4 jam </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu dan ajarkan pasien melakukan nafas dalam setiap 1 jam</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional </span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Meningkatkan ventilasi maksimal dan oksigenasi </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Atur posisi tidur semi fowler untuk meningkatkan ekspansi paru </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></i></span><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Duduk tinggi memungkinkan ekspansi paru dan memudahkan pernafasan</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau tanda vital setiap 1 jam </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional </span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Indikator umum, status sirkulasi dan keadekuatan perfusi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri punggung berhubungan dengan posisi tubuh miring ke lateral</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan </span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Nyeri berkurang atau hilang</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana tindakan :</span></b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji tipe, intensitas dan lokasi nyeri </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <i>Rasional :</i> Mempengaruhi pilihan / pengawasan keefektifan intervensi tingkat ansietas dapat mempengaruhi terhadap nyeri</span></span></div><div class="MsoListParagraph" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ajarkan relaksasi dan tehnik distraksi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <i>Rasional :</i> Untuk mengalihkan perhatian sehingga mengurangi nyeri</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ajarkan dan anjurkan pemakaian brace</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <i>Rasional :</i><b> </b>Untuk mengurangi nyeri saat aktivitas</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dalam pemberian analgesi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost"><i>Rasional :</i><b> </b>Untuk meredakan nyeri</span></span></div><div class="MsoListParagraphCxSpFirst" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; 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-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan mobilitas fisik berhubungan dengan postur tubuh yang tidak seimbang</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Meningkatkan mobilitas fisik</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana tindakan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji tingkat mobilitas fisik</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mempengaruhi pilihan / pengawasan keefektifan intervensi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingkatkan aktivitas jika nyeri berkurang</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Memberikan kesempatan untuk mengeluarkan energy</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu dan ajarkan latihan rentang gerak sendi aktif</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Meningkatkan kekuatan otot dan sirkulasi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Libatkan keluarga dalam melakukan perawatan diri</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Keluarga yang kooperatif dapat meringankan petugas, dan memberikan kenyamanan pada pasien</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan citra tubuh atau konsep diri yang berhubungan dengan postur tubuh yang miring ke lateral</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Meningkatkan citra tubuh</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span class="fullpost"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana tindakan</span></b></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan untuk mengungkapkan perasaan dan masalahnya</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Ekspresi emosi membantu pasien mulai menerima kenyataan </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri harapan yang realistik dan buat sasaran jangka pendek untuk memudahkan pencapaian</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span class="fullpost"><i>Rasional :</i> Harapan yang tidak realistik menyebabkan pasien mengalami kegagalan dan menguatkan perasaan-perasaan tidak berdaya</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri penghargaan untuk tugas yang di lakukan</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Penguatan positif meningkatkan harga diri dan mendorong pengulangan perilaku yang di harapkan</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri dorongan untuk merawat dari sesuai toleransi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: lime; line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span class="fullpost"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : </span></i></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan kemandirian</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><b style="color: lime;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><br clear="all" style="page-break-before: always;" /> </span></b> <div class="MsoNormal" style="color: lime;"><br />
</div><div align="center" class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAFTAR PUSTAKA</span></b></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alpers, Ann. 2006.Buku Ajar Pediatri Rudolph Vol. 3.Jakarta : EGC</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Doengoes, Marylinn. 1999. Rencana Asuhan Keperawatan. Jakarta : EGC</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nettina, Sandra, M. 2001. Pedoman Praktik Keperawatan. Jakarta : EGC</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ngastiyah. 2005. Perawatan Anak Sakit. Jakarta: EGC.</span></div><div class="MsoNormal" style="color: lime; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Price, Sylvia Anderson. 2005. Patofisiologi: Konsep Klinis Proses-Proses Penyakit. Jakarta: EGC<br />
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</span></div><div style="color: lime;"></div>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-33030257789159663442011-02-21T03:04:00.000-08:002011-02-21T03:04:16.862-08:00Askep Retardasi Mental<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoListParagraph" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Latar Belakang </span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi mental merupakan masalah dunia dengan implikasi yang besar terutama bagi Negara berkembang. Diperkirakan angka kejadian retardasi mental berat sekitar 0,3% dari seluruh populasi dan hampir 3% mempunyai IQ dibawah 70.Sebagai sumber daya manusia tentunya mereka tidak bias dimanfaatkan karena 0,1% dari anak-anak ini memerlukan perawatan, bimbingan serta pengawasan sepanjang hidupnya.(Swaiman KF, 1989).Prevalensi retardasi mental sekitar 1 % dalam satu populasi. Di indonesia 1-3 persen penduduknya menderita kelainan ini. Insidennya sulit di ketahui karena retardasi metal kadang-kadang tidak dikenali sampai anak-anak usia pertengahan dimana retardasinya masih dalam taraf ringan. Insiden tertinggi pada masa anak sekolah dengan puncak umur 10 sampai 14 tahun. Retardasi mental mengenai 1,5 kali lebih banyak pada laki-laki dibandingkan dengan perempuan. </span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sehingga retardasi mental masih merupakan dilema, sumber kecemasan bagi keluarga dan masyarakat. Demikian pula dengan diagnosis, pengobatan dan pencegahannya masih merupakan masalah yang tidak kecil. </span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Permasalahan </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana konsep teori retardasi mental?</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagamana pula memberikan asuhan keperawatan pada klien dengan retardasi mental?</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Tujuan </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui konsep teori<span> </span>retardasi mental pada anak.</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengetahui asuhan keperawatan pada klien dengan retardasi mental.</span></div><b style="color: red;"><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;"> </span></b> <div class="MsoNormal" style="color: red;"><br />
</div><div align="center" class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PEMBAHASAN</span></b></div><div class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pengertian Retardasi Mental</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 22.5pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RM menurut American Association on Mental Retardation</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (AAMR) 1992 : <span>Kelemahan/ketidakmampuan kognitif muncul pada masa kanak-kanak (sbl 18 tahun) ditandai<span> </span>dengan fs. kecerdasan<span> </span>dibawah normal ( IQ 70-75 atau kurang), dan disertai keterbatasan lain pada sedikitnya<span> </span>dua area berikut : berbicara dan berbahasa; ketrampilan merawat diri, ADL; ketrampilan sosial; penggunaan sarana masyarakat; kesehatan dan keamanan; akademik<span> </span>fungsional; bekerja dan rileks, dll.</span></span><span lang="EN-GB" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sedangkan menurut WHO,retardasi mental adalah kemampuan mental yang tidak mencukupi. </span><span lang="EN-GB" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retradasi mental adalah<i><span> </span>suatu keadaan yang ditandai dengan fs. Intelektual berada dibawah normal, timbul pada masa perkembangan/dibawah usia 18 tahun, berakibat lemahnya proses belajar dan adaptasi sosial (D.S.M/Budiman M, 1991)</i></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Crocker AC 1983, retardasi mental adalah apabila jelas terdapat fungsi iritelegensi yang rendah, yang disertai adanya kendala dalam penyesuaian perilaku, dan gejalanya timbul pada masa perkembangan. Sedangkan menurut Melly Budhiman, seseorang dikatakan retardasi mental, bila memenuhi kriteria sebagai berikut:</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi intelektual umum dibawah normal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat kendala dalam perilaku adaptif social</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejalanya timbul dalam masa perkembangan yaitu dibawah usia 18 tahun.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi Mental sering disepadankan dengan istilah-istilah, sebagai berikut:</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lemah Pikiran ( feeble-minded)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terbelakang Mental (Mentally Retarded)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bodoh atau Dungu (Idiot)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pandir (Imbecile)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tolol (moron)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Oligofrenia (Oligophrenia)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu Didik (Educable)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu Latih (Trainable)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ketergantungan Penuh (Totally Dependent) atau Butuh Rawat</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>10.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mental Subnormal</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>11.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Defisit Mental</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>12.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Defisit Kognitif</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>13.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cacat Mental</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>14.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Defisiensi Mental</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>15.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan Intelektual</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: 21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jadi, Retradasi mental adalah suatu gangguan heterogen yang terdiri dari gangguan fungsi intelektual dibawah rata-rata dan dan gangguan dalam keterampilan adaptif<span> </span>yang ditemukan sebelum orang berusia 18 tahun.</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Etiologi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya disfungsi otak merupakan dasar dari retardasi mental. Untuk mengetahui adanya retardasi mental perlu anamnesis yang baik, pemeriksaan fisik dan laboratorium. Penyebab dari retardasi mental sangat kompleks dan multifaktorial. Walaupun begitu terdapat beberapa faktor yang potensial berperanan dalam terjadinya retardasi mental seperti yang dinyatakan oleh Taft LT (1983) dan Shonkoff JP (1992) dibawah ini.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Organik <span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Faktor prekonsepsi : kelainan kromosom (trisomi 21/Down syndrome dan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Abnormalitas single gene (penyakit-penyakit metabolik, kelainan neurocutaneos, dll.)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor prenatal : kelainan petumbuhan otak selama kehamilan<span> </span>(infeksi, zat teratogen dan toxin, disfungsi plasenta)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor perinatal : prematuritas, perdarahan intrakranial, asphyxia neonatorum,</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Meningitis, Kelainan metabolik:hipoglikemia, hiperbilirubinemia, <span><span> </span>dll </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor postnatal : infeksi, trauma, gangguan metabolik/hipoglikemia, malnutrisi, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">CVA (Cerebrovascularaccident) - Anoksia, misalnya tenggelam</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Non organik </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kemiskinan dan klg tidak harmonis </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Sosial kultural </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Interaksi anak kurang </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Penelantaran anak </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor lain : Keturunan; pengaruh lingkungan dan kelainan mental lain (15-20% ; AAP, 1984)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Klasifikasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut nilai IQ-nya, maka intelegensi seseorang dapat digolongkan sebagai berikut (dikutip dari Swaiman 1989):</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nilai IQ :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sangat superior 130 atau lebih</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Superior 120-129</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diatas rata-rata 110-119</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rata-rata 90-110</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dibawah rata-rata 80-89</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi mental borderline 70-79</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi mental ringan (mampu didik) 52-69</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi mental sedang (mampu latih ) 36-51</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi mental berat 20-35</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>10.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi mental sangat berat dibawah 20</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang disebut retardasi mental apabila IQ dibawah 70, retardasi mental tipe ringan masih mampu didik, retardasi mental tipe sedang mampu latih, sedangkan retardasi mental tipe berat dan sangat berat memerlukan pengawasan dan bimbingan seumur hidupnya. Bila ditinjau dari gejalanya, maka <b>Melly Budhiman</b> membagi:</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tipe klinik<span> </span><br />
Pada retardasi mental tipe klinik ini mudah dideteksi sejak dini, karena kelainan fisis maupun mentalnya cukup berat. Penyebabnya sering kelainan organik. Kebanyakan anak ini perlu perawatan yang terus menerus dan kelainan ini dapat terjadi pada kelas sosial tinggi ataupun yang rendah. Orang tua dari anak yang menderita retardasi mental tipe klinik ini cepat mencari pertolongan oleh karena mereka melihat sendiri kelainan pada anaknya</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tipe sosio budaya<span> </span><br />
Biasanya baru diketahui setelah anak masuk sekolah dan ternyata tidak dapat mengikuti pelajaran. Penampilannya seperti anak normal, sehingga disebut juga retardasi enam jam. Karena begitu rnereka keluar sekolah, mereka dapat bermain seperti anakanak yang normal lainnya. Tipe ini kebanyakan berasal dari golongan sosial ekonomi rendah. Para orang tua dari anak tipe ini tidak melihat adanya ketainan pada anaknya, mereka mengetahui kalau anaknya retardasi dari gurunya atau dari psikolog, karena anaknya gagal beberapa kali tidak naik kelas. Pada urnumnya anak tipe ini mempunyai taraf IQ golongan borderline dan retardasi mental ringan.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; vertical-align: baseline;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klasifikasi Menurut Page :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Idiot (IQ dibawah 20; umur mental dibawah 3 tahun)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Imbisil (IQ antara 20-50, umur mental 3-7,5 tahun)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Moron ( IQ 50-70, umur mental 7,5-10,5 tahun)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; vertical-align: baseline;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tabel Derajat Retradasi Mental</span></b></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; color: red; margin-left: 5.4pt; width: 624px;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 70.9pt;" valign="top" width="95"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Derajat RM</span></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">IQ</span></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 4cm;" valign="top" width="151"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia Prasekolah</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(0-5 tahun)</span></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 137.7pt;" valign="top" width="184"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia Sekolah</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(0-21 tahun)</span></div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" valign="top" width="138"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia Dewasa</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(>21 tahun)</span></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 70.9pt;" valign="top" width="95"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sangat berat</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sedang </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ringan </span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><20</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">20-23</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">35-49</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">50-69</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 4cm;" valign="top" width="151"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retradasi jelas</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perkembangan motorik yang miskin</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat berbicara atau belajar berkomunikasi, ditangani dengan pengawasan sedang</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat mengembangkan keterampilan social dan komunikasi, retradasi minimal</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 137.7pt;" valign="top" width="184"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beberapa Perkembangan motorik dapat berespon namun terbatas</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat bicara atau berkomunikasi namun latuhan kejujuran tidak bermanfaat</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latihan dalam keterampilan social dan pekerjaan dapat bermanfaat, dapat pergi sendiri ketempat yang telah dikenal</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat belajar keterampilan akademik sampai ± kelas 6 SD</span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 103.3pt;" valign="top" width="138"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perkembangan motorik dan bicara sangat terbatas</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat berperan sebagian dalam pemeliharaan diri sendiri dibawah pengawasan ketat</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat bekerja sendiri tanpa dilatih namun perlu pengawasan terutama jika berada dalam stress</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biasanya dapat mencapai keterampilan social dan kejujuran namun perlu bantuan terutama bila stres</span></div></td> </tr>
</tbody></table><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Manifestasi Klinik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala klinis retardasi mental terutama yang berat sering disertai beberapa kelainan fisik yang merupakan stigmata kongenital, yang kadang-kadang gambaran stigmata mengarah kesuatu sindrom penyakit tertentu. Dibawah ini beberapa kelainan fisik dan gejala yang sering disertai retardasi mental, yaitu (Swaiman, 1989):</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan pada mata</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan kulit</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan rambut</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kepala</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perawakan pendek</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Distonia</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sedangkan gejala dari retardasi mental tergantung dari tipenya, adalah sebagai berikut:</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retradasi Mental Ringan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keterampilan social dan komunikasinya mungkin adekuat dalam tahun-tahun prasekolah. Tetapi saat anak menjadi lebih besar, deficit koognitif tertentu seperti kemampuan yang buruk untuk berpikir abstrak dan egosentrik mungkin membedakan dirinya dari anak lain seusianya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retradasi Mental Sedang</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keterampilan komunikasi berkembang lebih lambat. Isolasi social dirinya mungkin<span> </span>dimulai pada usia sekolah dasar. Dapat dideteksi lebih dini jika dibandingkan retradasi mental ringan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retradasi Mental Berat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bicara anak terbatas dan perkembangan motoriknya buruk. Pada usia prasekolah sudah nyata ada gangguan. Pada usia sekolah mungkin kemampuan bahasanya berkembang. Jika perkembangan bahasanya buruk, bentuk komunikasi nonverbal dapat berkembang.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retradasi Mental Sangat Berat</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keterampilan komunikasi dan motoriknya sangat terbatas. Pada masa dewasa dapat terjadi perkembangan bicara dan mampu menolong diri sendiri secara sederhana. Tetapi seringkali masih membutuhkan perawatan orang lain.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat ciri klinis lain yang dapat terjadi sendiri atau menjadi bagian dari gangguan retradasi mental , yaitu hiperakivitas, toleransi frustasi yang rendah, agresi, ketidakstabilan efektif , perilaku motorik stereotipik berulang, dan perilaku melukai diri sendiri.</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><strong><span style="font-size: 14pt; line-height: 150%;">Patofisiologi</span></strong><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Retardasi mental merujuk pada keterbatasan nyata fungsi hidup sehari-hari. Retardasi mental ini termasuk kelemahan atau ketidakmampuan kognitif yang muncul pada masa kanak-kanak ( sebelum usia 18 tahun ) yang ditandai dengan fungsi kecerdasan di bawah normal ( IQ 70 sampai 75 atau kurang ) dan disertai keterbatasan-keterbatasan lain pada sedikitnya dua area fungsi adaftif : berbicara dan berbahasa , kemampuan/ketrampilan merawat diri, kerumahtanggaan, ketrampilan sosial, penggunaan sarana-sarana komunitas, pengarahan diri , kesehatan dan keamanan , akademik fungsional, bersantai dan bekerja.<span> </span><br />
Penyebab retardasi mental bisa digolongkan kedalam prenatal, perinatal dan pasca natal. Diagnosis retardasi mental ditetapkan secara dini pada masa kanak-kanak.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><img height="312" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image003.jpg" width="616" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Penatalaksanaan Medis <span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<span> </span>Terapi terbaik adalah pencegahan primer, sekunder dan tersier.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pencegahan primer</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah tindakan yang dilakukan untuk menghilangkan atau menurunkan kondisi yang menyebabkan gangguan. Tindakan tersebut termasuk pendidikan untuk meningkatkan pengetahuan dan kesadaran masyarakat umum, usaha terus menerus dari profesional<span> </span>bidang kesehatan untuk menjaga dan memperbaharui kebijakan kesehatan masyarakat , aturan untuk memberikan pelayanan kesehatan maternal dan anak yang optimal, dan eredekasi gangguan yang diketahui disertai kerusakan system saraf pusat. Konseling keluarga dan genetic dapat membantu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan <i>pencegahan sekunder</i> adalah untuk mempersingkat perjalanan penyakit. </span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sedangkan <i>pencegahan tersier</i> bertujuan untuk menekan kecacatan yang terjadi. Dalam pelaksanaanya kedua jenis pencegahan ini dilakuakn bersamaan, yang meliputi pendidikan untuk anak : terapi perilaku, kognitif dan psikodinamika ; pendidikan keluarga; dan intervensi farmakologi. Pendidikan untuk anak harus merupakan program yang lengkap dan mencakup latihan keterampilan adaptif, sosialn, dan kejuruan. Satu hal yang penting dalam mendidik keluarga tentang cara meningkatkan kopetensi dan harga diri sambil mempertahankan harapan yang realistic.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengatasi perilaku agresif dan melukai diri sendiri dapat digunakan naltrekson. Untuk gerakan motorik stereotopik dapat dipakai antipsikotik seperti haloperidol dan klorpromazin. Perilaku kemarahan eksplosif dapat diatasi dengan penghambat beta seperti propranolol dan buspiron. Adapun untuk gangguan deficit atensi atau hiperktivitas dapat digunakan metilpenidat.</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; letter-spacing: 0.5pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; letter-spacing: 0.5pt; line-height: 150%;">Komplikasi </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;">Menurut Betz, Cecily R (2002) komplikasi retardasi mental adalah :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;">Serebral palsi </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;">Gangguan kejang </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;">Gangguan kejiwaan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;">Gangguan konsentrasi / hiperaktif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;">Deficit komunikasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;">Konstipasi (karena penurunan motilitas usus akibat obat-obatan, kurang mengkonsumsi makanan berserat dan cairan).</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; letter-spacing: 0.5pt; line-height: 150%;"><span>H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; letter-spacing: 0.5pt; line-height: 150%;">Insiden <span> </span></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.35pt; line-height: 150%;">Prevalensi retardasi mental sekitar 1 % dalam satu populasi. Di indonesia 1-3 persen penduduknya menderita kelainan ini.4 Insidennya sulit di ketahui karena retardasi metal kadang-kadang tidak dikenali sampai anak-anak usia pertengahan dimana retardasinya masih dalam taraf ringan. Insiden tertinggi pada masa anak sekolah dengan puncak umur 10 sampai 14 tahun. Retardasi mental mengenai 1,5 kali lebih banyak pada laki-laki dibandingkan dengan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.5pt; line-height: 150%;">perempuan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: 0.35pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pemeriksaan Penunjang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan kromosom</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan urin, serum atau titer virus</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Test diagnostik spt : EEG, CT Scan untuk identifikasi abnormalitas perkembangan jaringan otak, injury jaringan otak atau trauma yang mengakibatkan perubahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>J.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pencegahan </span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Imunisasi bagi anak dan ibu sebelum kehamilan</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Konseling perkawinan</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan kehamilan rutin</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nutrisi yang baik</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Persalinan oleh tenaga kesehatan</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memperbaiki sanitasi dan gizi keluarga</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pendidikan kesehatan mengenai pola hidup sehat</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Program mengentaskan kemiskinan, dll</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><span style="color: red; font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;"></span><br style="color: red;" /> <div align="center" class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB III</span></div><div align="center" class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PROSES KEPERAWATAN</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Pengkajian</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data demografi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas Klien</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas Orang tua</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat Kesehatan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda dan gejala : </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengenali sindrom seperti adanya mikrosepali </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya kegagalan perkembangan yang merupakan indikator RM seperti anak <span>RM berat </span>biasanya mengalami kegagalan perkembangan pada tahun pertama kehidupannya, terutama psikomotor; <span>RM sedang </span>memperlihatkan penundaan pada kemampuan bahasa dan bicara, dengan kemampuan motorik normal-lambat, biasanya terjadi pada usia 2-3 tahun; <span>RM ringan </span>biasanya terjadi pada usia sekolah dengan memperlihatkan kegagalan anak untuk mencapai kinerja yang diharapkan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan neurologis yang progresif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingkatan/klasifikasi RM (APA dan Kaplan; Sadock dan Grebb, 1994)</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ringan ( IQ 52-69; umur mental 8-12 tahun) </span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: 36pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Karakteristik : </span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia presekolah tidak tampak sebagai anak RM, ttp terlambat dalam kemampuan berjalan, bicara , makan sendiri, dll </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia sekolah, dpt melakukan ketrampilan, membaca dan aritmatik, diarahkan pada kemampuan aktivitas sosial.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia dewasa, melakukan ketrampilan sosial dan vokasional, diperbolehkan menikah tidak dianjurkan memiliki anak. Ketrampilan psikomotor tidak berpengaruh kecuali koordinasi. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sedang ( IQ 35- 40 hingga 50 - 55; umur mental 3 - 7 tahun) </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Karakteristik : </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia presekolah, kelambatan terlihat pada perkembangan motorik, terutama bicara, respon saat belajar dan perawatan diri.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia sekolah, dapat mempelajari komunikasi sederhana, dasar kesehatan, perilaku aman, serta ketrampilan mulai sederhana, Tidak ada kemampuan membaca dan berhitung. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia dewasa, melakukan aktivitas latihan tertentu, berpartisipasi dalam rekreasi, dapat melakukan perjalanan sendiri ke tempat yg dikenal, tidak bisa membiayai sendiri. </span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat ( IQ 20-25 s.d. 35-40; umur mental < 3 tahun)</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: 36pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Karakteristik : </span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia prasekolah kelambatan nyata pada perkembangan motorik, kemampuan komunikasi sedikit bahkan tidak ada, bisa berespon dalam perawatan diri tingkat dasar sepeti makan. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia sekolah, gangguan spesifik dlm kemampuan berjalan, memahami sejumlah komunikasi/berespon, membantu bila dilatih sistematis. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia dewasa, melakukan kegiatan rutin dan aktivitas berulang, perlu arahan berkelanjutan dan protektif lingkungan, kemampuan bicara minimal, meggunakan gerak tubuh. </span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sangat Berat ( IQ dibawah 20-25; umur mental seperti bayi)</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: 36pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Karakteristik : </span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia prasekolah retardasi mencolok, fungsi. Sensorimotor minimal, butuh perawatan total. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia sekolah, kelambatan nyata di semua area perkembangan, memperlihatkan respon emosional dasar, ketrampilan latihan kaki, tangan dan rahang. Butuh pengawas pribadi. Usia mental bayi muda. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 112.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span><img alt="*" height="13" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usia dewasa, mungkin bisa berjalan, butuh perawatan total, biasanya diikuti dengan kelainan fisik. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan fisik :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kepala : Mikro/makrosepali, plagiosepali (bentuk kepala tidak simetris)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rambut : Pusar ganda, rambut jarang/ tidak ada, halus, mudah putus dan cepat berubah</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mata : mikroftalmia, juling, nistagmus, dll</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hidung : jembatan/punggung hidung mendatar, ukuran kecil, cuping melengkung keatas, dll</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mulut : bentuk “V” yang terbalik dari bibir atas, langit-langit lebar/ melengkung tinggi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Geligi : odontogenesis yang tidak normal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Telinga : keduanya letak rendah; dll</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Muka : panjang filtrum yang bertambah, hipoplasia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Leher : pendek; tidak mempunyai kemampuan gerak sempurna</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>j.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tangan : jari pendek dan tegap atau panjang kecil meruncing, ibu jari gemuk dan lebar, klinodaktil, dll</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>k.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dada & Abdomen : terdapat beberapa putting, buncit, dll</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>l.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Genitalia : mikropenis, testis tidak turun, dll</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>m.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaki : jari kaki saling tumpang tindih, panjang & tegap/ panjang kecil meruncing diujungnya, lebar, besar, gemuk. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan penunjang </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan kromosom</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaanurin, serum atau titer virus</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Test diagnostic sepetti : EEG, CT Scan untuk identifikasi abnormalitas perkembangan jaringan otak, injury jaringan otak atau trauma yang mengakibatkan perubahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Diagnosis Keperawatan </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pertumbuhan dan perkembangan b/d kelainan fungsi Kognitif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan komunikasi verbal b/d lambatnya keterampilan ekspresi dan resepsi bahasa.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko cedera b/d perilaku agresif/ koordinasi gerak tidak terkontrol</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan interaksi sosial b/d kesulitan bicara /kesulitan adaptasi sosial</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan proses keluarga b/d memiliki anak RM</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Defisit perawatan diri: makan, mandi, berpakaian/ berhias, toileting b/d ketidakmampuan fisik dan mental/ kurangnya kematangan perkembangan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Rencana Intervensi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :</span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx<span> </span>: Gangguan pertumbuhan dan perkembangan b/d kelainan fungsi Kognitif</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : pertumbuhan dan perkembangan berjalan sesuai tahapan</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji faktor penyebab gangguan perkembangan anak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi dan gunakan sumber pendidikan untuk memfasilitasi perkembangan anak yang optimal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan aktivitas stimulasi yang sesuai dengan usia </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau pola pertumbuhan (tinggi badan, berat badan, lingkar kepala dan rujuk ke ahli gizi untuk mendapatkan intervensi nutrisi)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx : kerusakan komunikasi verbal b/d lambatnya keterampilan ekspresi dan resepsi bahasa.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : komunikasi terpenuhi sesuai tahap perkembangan anak. </span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi : </span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingkatkan komunikasi verbal dan stimulasi taktil</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan intruksi berulang dan sederhana</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri waktu yang cukup untuk berkomunikasi. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dorong komunikasi terus menerus dengan dunia luar contoh Koran, televises, radio, kalender, jam. </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx : Risiko cedera b/d perilaku agresif/ koordinasi gerak tidak terkontrol</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : menunjukkan perubahan perilaku, pola hidup untuk menurunkan factor risiko dan untuk melindungi diri dari cedera.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi : <span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan posisi yang aman dan nyaman.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manajemen perilaku anak yang sulit</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Batasi aktifitas yang berlebihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ambulasi dengan bantuan ; berikan kamar mandi khusus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx : Gangguan interaksi sosial b/d kesulitan bicara /kesulitan adaptasi social</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : <span>meminimalkan gangguan interaksi social</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu anak dalam mengidentifikasi kekuatan pribadi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri pengetahuan terhadap orang terdekat anak mengenai Retardasi Mental</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dorong anak untuk berpartisipasi dalam aktivitas bersama anak-anak dan keluarga lain</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dorong anak mempertahankan hubungan dengan teman-teman <span> </span><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan reinforcement positif atas hasil yang dicapai anak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx : Gangguan proses keluarga b/d memiliki anak RM</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : <span>keluarga menunjukkan pemahaman tentang penyakit anak dan terapinya</span></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi : </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji pemahaman keluarga tentang penyakit anak dan rencana perawatan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tekankan dan jelaskan penjelasan tim kesehatan lain tentang kondisi anak, prosedur dan terapi yang dianjurkan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gunakan setiap kesempatan untuk meningkatkan pemahaman keluarga tentang penyakit dan terapinya </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 58.5pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ulangi informasi sesering mungkin </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx : Defisit perawatan diri b/d ketidakmampuan fisik dan mental/ kurangnya kematangan perkembangan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan : melakukan perawatan diri sesuai tingkat usia dan perkembangan anak.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi kebutuhan akan kebersihan diri dan berikan bantuan sesuai kebutuhan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi kesulitan dalam perawatan diri, seperti keterbatasan gerak fisik, penurunan kognitif. </span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dorong anak melakukan perawatan sendiri</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; vertical-align: baseline;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pendidikan pada orangtua</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perkembangan anak untuk tiap tahap usia</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dukung keterlibatan orangtua dalam perawatan anak</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bimbingan antisipasi dan manajemen menghadapi perilaku anak yang sulit</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Informasikan sarana pendidikan yang ada dan kelompok, dll</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Evaluasi </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak berfungsi optimal sesuai tingkatannya.</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat berkomunikasi dengan baik sesuai usia.</span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perilaku dan pola hidup anak jauh dari risiko cidera.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak</span> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">berpartisipasi dalam aktivitas bersama anak-anak dan keluarga lain.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluarga menunjukkan pemahaman tentang penyakit anak dan terapinya.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak melakukan perawatan diri sesuai tingkat usia dan perkembangan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">BAB IV</span></div><div align="center" class="MsoNormal" style="color: red; line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 150%;">PENUTUP</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Kesimpulan </span></div><div class="MsoListParagraphCxSpLast" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retradasi mental adalah suatu gangguan heterogen yang terdiri dari gangguan fungsi intelektual dibawah rata-rata dan dan gangguan dalam keterampilan adaptif<span> </span>yang ditemukan sebelum orang berusia 18 tahun.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor yang potensial berperanan dalam terjadinya retardasi mental : <span>organik</span>, <span>non organik </span>dan faktor lain (Keturunan; pengaruh lingkungan dan kelainan mental lain).</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klasifikasi RM menurut IQ-nya yaitu retardasi mental borderline 70-79, retardasi mental ringan (mampu didik) 52-69, retardasi mental sedang (mampu latih ) 36-51, retardasi mental berat 20-35, dan retardasi mental sangat berat dibawah 20.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun diagnosa keperawatan yang dapat ditegakkan antara lain :</span></div><div class="MsoListParagraphCxSpFirst" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pertumbuhan dan perkembangan b/d kelainan fungsi Kognitif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan komunikasi verbal b/d kelainan fungsi kognitif</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko cedera b/d perilaku agresif/ ketidakseimbangan mobilitas fisik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan interaksi sosial b/d kesulitan bicara /kesulitan adaptasi sosial</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan proses keluarga b/d memiliki anak RM</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt; vertical-align: baseline;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Defisit perawatan diri b/d perubahan mobilitas fisik/ kurangnya kematangan perkembangan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Saran </span></div><div class="MsoListParagraphCxSpMiddle" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penulis berharap kepada pembaca khususnya kami sendiri agar dapat meningkatkan lagi ilmu dan pengetahuan yang dimiliki dibidang Keperawatan anak khususnya yang terkait dengan Retardasi Mental pada anak.</span></div><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: red; margin-bottom: 0.0001pt; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;">DAFTAR PUSTAKA</span></b></div><div align="center" class="MsoNormal" style="color: red; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Doengoes, Marilynn E. 2000. <i>Rencana Asuhan Keperawatan : Pedoman untuk Perencanaan dan Pendokumentasian Perawatan pasien</i>. Jakarta : Penerbit Buku Kedokteran, EGC</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KTI.2010. </span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi Menta</span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">l ( </span></i><span lang="IN"><a href="http://www.askep-askeb.cz.cc/2010/08/retardasi-mental.html"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://www.askep-askeb.cz.cc/2010/08/retardasi-mental.html</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, diakses tanggal 20 Desember 2010)</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mansjoer, Arif., Suprohaita, Wardhani, W.A., dan Setiowulan, wiwiek │Eds.│. <i>Kapita Selekta Kedokteran</i>. Jakarta : Media Auscalapius.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rohmah, Nikmatur dan Walid, Saiful. 2009. <i>Proses Keperawatan Teori dan Aplikasi</i>. Jogjakarta : Ar-Ruzz Media.</span></div><div class="MsoNormal" style="color: red; line-height: 150%; margin: 0cm 0cm 0.0001pt 1cm; text-indent: -1cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Santa Teresa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. 2010. (</span><span lang="IN" style="color: red;"><a href="http://www.asterpix.com/tagcloudclick/?id=2437661&url=http%3A//scribd.asterpix.com/cy/2437661/%3Fq%3D&tag=Asuhan%20Keperawatan%20Jiwa%20Retardasi&q=mental%20retardasi%20keperawatan&referer=http%3A%2F%2Fwww.scribd.com%2Fdoc%2F29385639%2FASKEP-JIWA-RETARDASI-MENTAL-RM&ct=3&t=1292936078"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://www.asterpix.com/tagcloudclick/?id=2437661&url=http%3A//scribd.asterpix.com/cy/2437661/%3Fq%3D&tag=Asuhan%20Keperawatan%20Jiwa%20Retardasi&q=mental%20retardasi%20keperawatan&referer=http%3A%2F%2Fwww.scribd.com%2Fdoc%2F29385639%2FASKEP-JIWA-RETARDASI-MENTAL-RM&ct=3&t=1292936078</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, diakses tanggal 20 Desember 2010)</span></div><span lang="IN" style="color: red; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Staf Pengajar Ilmu Kesehatan Anak. 1985. <i>Buku Kuliah 3 Ilmu Kesehatan Anak</i>. 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<div align="center" class="MsoNormal" style="background-color: white; color: blue; line-height: 150%; margin-left: -36pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">KONSEP PENYAKIT</span></b></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DEFINISI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 31.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Congenital Dislocation Of The Hip (CDH) adalah deformitas ortopedik yang didapat segera sebelum atau pada saat kelahiran.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ETIOLOGI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kebanyakan bayi yang lahir dengan Congenital dislocatoin of hip memiliki orang tua yang jelas-jelas tidak memiliki gangguan kesehatan maupun faktor resiko. Seorang wanita hamil yang telah mengikuti semua nasihat dokternya agar kelak melahirkan bayi yang sehat, mungkin saja nanti melahirkan bayi yang memiliki kelainan bawaan. 60% kasus kelainan bawaan penyebabnya tidak diketahui; sisanya disebabkan oleh faktor lingkungan atau genetik atau kombinasi dari keduanya.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Teratogenik</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Teratogen adalah setiap faktor atau bahan yang bisa menyebabkan atau meningkatkan resiko suatu kelainan bawaan. Radiasi, obat tertentu dan racun merupakan teratogen.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gizi</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menjaga kesehatan janin tidak hanya dilakukan dengan menghindari teratogen, tetapi juga dengan mengkonsumsi gizi yang baik. </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Salah satu zat yang penting untuk pertumbuhan janin adalah asam folat. Kekurangan asam folat bisa meningkatkan resiko terjadinya spina bifida atau kelainan tabung saraf lainnya. Karena spina bifida bisa terjadi sebelum seorang wanita menyadari bahwa dia hamil, maka setiap wanita usia subur sebaiknya mengkonsumsi asam folat minimal sebanyak 400 mikrogram/hari.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor fisik pada rahim</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di dalam rahim, bayi terendam oleh cairan ketuban yang juga merupakan pelindung terhadap cedera. Jumlah cairan ketuban yang abnormal bisa menyebabkan atau menunjukkan adanya kelainan bawaan. </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cairan ketuban yang terlalu sedikit bisa mempengaruhi pertumbuhan paru-paru dan anggota gerak tubuh atau bisa menunjukkan adanya kelainan ginjal yang memperlambat proses pembentukan air kemih. </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penimbunan cairan ketuban terjadi jika janin mengalami gangguan menelan, yang bisa disebabkan oleh kelainan otak yang berat (misalnya anensefalus atau atresia esofagus).</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor genetik dan kromosom</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Genetik memegang peran penting dalam beberapa kelainan bawaan. Beberapa kelainan bawaan merupakan penyakit keturunan yang diwariskan melalui gen yang abnormal dari salah satu atau kedua orang tua. </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gen adalah pembawa sifat individu yang terdapat di dalam kromosom setiap sel di dalam tubuh manusia. Jika 1 gen hilang atau cacat, bisa terjadi kelainan bawaan.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">MANIFESTASI KLINIK</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Bayi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Kemungkinan tidak ada bukti gejala karena bayi dapat mengalami kesalahan tempat femur minimal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Lipatan gluteal yang tidak sejajar (posisi pronasi)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pemendekan ekstremitas pada tempat yang terkena</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Abduksi terbatas pada pinggul sisi yang terkena</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Adanya tanda-tanda Galeazzi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Temuan positif saat dilakukan Manuver Barlow</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Temuan positif saat dilakukan maneuver ortolani</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Toddler dan anak yang lebih tua</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Gaya berjalan seperti bebek (dislokasi pinggul bilateral)</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Peningkatan lordosis lumbal (punggung cekung) saat berdiri (dislokasi pinggul bilateral)</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Tungkai yang terkena lebih pendek dari yang lain</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Temuan positif pada uji trendeelenburg</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Pincang.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PATOFISIOLOGI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Dysplasia perkembangan pinggul (developmental dysplasia of the hip, DDH),atau congenital dislocation of the hip, merupakan ketidaknormalan perkembangan antara kaput femur dan asetabulum. Pinggul merupakan suatu bonggol (kaput femur) dan mangkuk (asetabulum) sendi yang memberikan gerakan dan stabilitas pinggul. Terdapat tiga pola dalam CDH :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Dysplasia asetabular (perkembangan tidak normal )- keterlambatan dalam perkembangan asetabulum sehingga lebih dangkal dari normal, kaput femur tetap dalam asetabulum ;</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Subluksasi – dislokasi pinggul yang tidak normal ; kaput femur tidak sepenuhnya keluar dari asetabulum dan dapat berdislokasi secara parsial ; dan</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Dislokasi – pinggul berada pada posisi dislokasi, dan kaput femur tidak bersentuhan dengan asetabulum. DDH pada akhirnya dapat berkembang menjadi reduksi permanen, dislokasi lengkap, atau dysplasia akibat perubahan adaptif yang terjadi pada jaringan dan tulang yang berdekatan.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENATALAKSANAAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penanganan bervariasi sesuai keparahan manifestasi klinis, usia anak, dan tingkat dysplasia. Jika dislokasi terkoreksi pada pada beberapa hari pertama sampai beberapa minggu kehidupan, kesempatan untuk berkembangnya pinggul normal akan lebih besar. Selama periode neonatal, pengaturan posisi dan mempertahankan pinggul tetap fleksi dan abduksi dapat dicapai dengan menggunakan alat bantu pengoreksi. Antara usia 6 dan 18 bulan, traksi digunakan diikuti dengan imobilisasi gips. Jika jaringan lunak menghalangi dan menyulitkan penurunan dan perkembangan sendi, dilakukan reduksi tertutup maupun terbuka (bergantung pada apakah ada atau tidak kontraktur otot-otot adductor dan kesalahan letak kaput femur yang terjadi) dan gips spika pinggul di pasang</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KOMPLIKASI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Displasia asetabular persisten</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dislokasi berulang</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nekrosis avaskular iatrogenic pada kaput femur</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">INSIDEN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">CDH terjadi pada 1 atau 1,2 dari 100 kelahiran hidup</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Di Amerika serikat, sekitar 38.900 sampai 46.000 bayi terkena setiap tahun.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Rasio wanita/pria adalah 6 : 1</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Insidens meningkat dengan adanya presentasi bokong.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Peningkatan insidens terbukti<span> </span>diantara saudara kandung anak yang terinfeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Bila hanya 1 pinggul yang terkena, pinggul kiri lebih sering terkena dari pada pinggul kanan</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Sering ada hubungannya<span> </span>dengan ketidaknormalan muskuluskeletal dan renal congenital lain.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Peningkatan insidens terlihat diantara kultur<span> </span>yang membedung<span> </span>bayi terlalu rapat dan mengikat bayi pada papan ayunan selama bulan-bulan awal kehidupan.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif";"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif";">Ada hubungan antara CDH dan perkembangan arthritis pinggul sekunder pada awal masa dewasa.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif";"><span>H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMERIKSAAN DIAGNOSTIK</span></b><b><span style="font-family: "Times New Roman","serif";"></span></b></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan radiografi pelvis anteroposterior dan lauenstein lateral didapatkan (kaji tingkat kesalahan letak atau dislokasi femur ; tidak berguna pada bayi yang berusia kurang dari 1 bulan). Ultrasonografi, CT scan, dan MRI juga digunakan.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="background-color: white; color: blue;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><br />
</span></div><b style="background-color: white; color: blue;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%;"> </span></b> <div align="center" class="MsoNormal" style="background-color: white; color: blue; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">ASUHAN KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGKAJIAN</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian muskuloskeletal</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi motorik kasar</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukuran otot : adanya atrofi atau hipertrofi otot ; kesimetrisan massa otot</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tonus otot : spastisitas, kelemahan, rentang gerak terbatas</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kekuatan</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gerakan abnormal : tremor, distonia, atetosis</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi motorik halus</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manipulasi mainan</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menggambar</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gaya berjalan : ayunan lengan dan kaki, gaya tumit – jari</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengendalian postur</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan posisi tegak</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya ataksia</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bergoyang-goyang</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Persendian</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rentang gerak</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kontraktur</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemerahan, edema, nyeri</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tonjolan abnormal</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tulang belakang</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lengkung tulang belakang : skoliosis, kifosis</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya lesung pilonidal</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pinggul</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Abduksi</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: blue; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adduksi</span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Criteria pengkajian </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Maneuver ortolani</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Maneuver barlow</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda galeazzi</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Uji trendelenburg</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji tanda – tanda iritasi kulit</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji respon anak terhadap traksi dan imobilisasi dengan adanya gips spika.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji tingkat perkembangan anak</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji kemampuan pasien untuk mengelola perawatan gips spika di rumah.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DIAGNOSA</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman nyeri berhubungan dengan dislokasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan mobilitas fisik berhubungan dengan nyeri saat mobilisasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan bodi image berhubungan dengan perubahan bentuk tubuh</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RENCANA TINDAKAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman nyeri berhubungan dengan dislokasi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan :Nyeri dapat berkurang atau hilang</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Criteria hasil : Nyeri berkurang, Klien tampak tenang </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Kaji tingkat nyeri</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Untuk mengetahui skala Nyeri</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Atur posisi senyaman mungkin</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Menurunkan tingkat ketegangan pada daerah nyeri</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Ajarkan tekhnik relaksasi</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Merelaksasi otot-otot tubuh</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Kolaborasi pemberian analgetik</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Menghiangkan rasa nyeri</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan mobilitas fisik berhubungan dengan nyeri saat mobilisasi</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan :<span> </span>Klien dapat bergerak bebas </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Criteria hasil : Klien dapat bergerak bebas</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Kaji tingkat mobilisasi klien</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengidentifikasi lingkup masalah secara dini, sebagai pedoman tindakan selanjutnya</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Beri latihan ROM</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Memulihkan atau meningkatkan fungsi sendi dan kekuatan otot yang berkurang karena proses penyakit atau kecelakaan</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Anjurkan alat bantu jika dibutuhkan </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : membantu dalam melakukan suatu hal</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan body image berhubungan dengan perubahan bentuk tubuh tujuan : Masalah klien teratasi</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Criteria hasil : Klien dapat menungkapkan masalahnya</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Kaji konsep diri</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengidentifikasi lingkup masalah secara dini, sebagai pedoman tindakan selanjutnya</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Bantu klien mengungkapkan masalahnya</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Memberikan minat dan perhatian serta memperbaiki kesalahan konsep</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan dukungan spiritual kepada klien</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Agar klien tetap bersemangat dan tidak berputus asa terhadap perubahan status kesehatannya</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">EVALUASI</span></b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil yang diharapkan</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pinggul bayi atau anak akan tetap pada posisi yang diharapkan</span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: blue; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; 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</style> <![endif]--> <div align="center" class="MsoNormal" style="background-color: white; color: blue; line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAFTAR PUSTAKA</span></b></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: blue; line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Betz, Cecily Lynn dan Linda A.Sowden. 2009 . Buku Saku Keperawatan Pediatrik. Edisi 5.Jakarta : EGC</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Doenges, Marilynn E, dkk. 2000. Rencana Asuhan Keperawatan ; Pedoman Untuk Perencanaan dan Pendokumentasian Perawatan Pasien. Edisi 3. Jakarta EGC.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ratnayantinasrum.2010.blogspot.com (di akses 18 desember 2010)</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: blue; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Wong, Donna L. 2004. Pedoman Klinis Keperawatan Pediatrik. Edisi 4. Jakarta : EGC</span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: blue; line-height: 150%; margin-left: 1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Erika, Kadek Ayu, dkk. 2008. Keperawatan Anak. Makasar : SIK UNHAS</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-2795088580713620852011-02-19T04:07:00.000-08:002011-02-19T04:25:17.563-08:00Askep Impetigo<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac><br />
<div align="center" class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">L</span>atar Belakang</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Penyakit kulit karena infeksi bakteri yang sering diterdapat pada bayi disebut pioderma. Pioderma disebabkan oleh bakteri gram positif staphyllococcus, terutama S. aureus dan streptococcus atau keduanya. Faktor predisposisinya yaitu higiene yang kurang, menurunnya daya tahan tubuh mengidap penyakit menahun, kurang gizi, keganasan atau kanker dan sebagainya atau adanya penyakit lain di kulit yang menyebabkan fungsi perlindungan kulit terganggu.</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="EN-GB">Pioderma merupakan penyakit yang sering dijumpai. Sebenarnya infeksi kulit, selain disebabkan oleh bakteri gram positif seperti pada pioderma, dapat pula disebabkan oleh bakteri gram negatif, misalnya Pseudomonas aeruginosa, Proteus vulgaris, Proteus mirabilis, E. coli dan klebsiella. Seperti yang dijelaskan sebelumnya Penyebab yang umum ialah bakteri gram positif, yakni streptokokus dan stafilokokus.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><b><span style="font-weight: normal;">Terdapat beberapa jenis pioderma salah satunyayaitu impetigo. </span></b><span lang="EN-GB">Impetigo, yaitu merupakan salah satu bentuk pioderma yang paling sering menyerang anak-anak, terutama yang kebersihan badannya kurang dan bisa muncul di bagian tubuh manapun setelah terjadi cidera pada kulit, seperti luka maupun pada infeksi virus herpes simpleks. </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="EN-GB">Paling sering ditemukan di wajah, lengan dan tungkai. Pada dewasa, impetigo bisa terjadi setelah penyakit kulit lainnya. Impetigo bisa juga terjadi setelah suatu infeksi saluran pernafasan atas (misalnya flu atau infeksi virus lainnya).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Tujuan</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Adapun tujuan dari penulisan makalah ini yaitu untuk mngetahui konsep dasar dari asuhan keperawatan untuk penyakit pada system integumen, khusunya untuk kelompok kami membahas asuhan keperawatan pada impetigo. Kemudian, tujuan yang lebih khusunya adalah untuk melatih kita dalam menyusun atau membuat asuhan keperawatan dari pengkajian sampai pada evaluasi.</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Masalah</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Masalah yang muncul adalah, apa yang dimaksud dengan pioderma, etiologi, gejala, manifestasi klinik, penatalksanaannya serta bagaimana asuhan keperawatannya?</div><b style="background-color: cyan; color: black;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><br clear="all" style="page-break-before: always;" /> </span></b> <div class="MsoNormal" style="background-color: cyan; color: black;"><br />
</div><div align="center" class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ASUHAN KEPERAWATAN PADA ANAK DENGAN IMPETIGO</span></b></div><div align="center" class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KONSEP DASAR</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN">Definisi</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Impetigo adalah salah satu contoh pioderma, yang menyerang lapisan epidermis kulit (Djuanda, 56:2005). Impetigo biasanya juga mengikuti trauma superficial dengan robekan kulit dan paling sering merupakan penyakit penyerta (secondary infection) dari Pediculosis, Skabies, Infeksi jamur, dan pada insect bites (Beheshti, 2:2007).</span><span lang="IN"> </span><span lang="IN">Impetigo krustosa juga dikenal sebagai impetigo kontangiosa, impetigo vulgaris, atau impetigo Tillbury Fox. Impetigo bulosa juga dikenal sebagai impetigo vesikulo-bulosa atau cacar monyet (Djuanda, 56-57:2005).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Klasifikasi</b></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 27pt;"><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis impetigo yaitu :</span></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">1.</span><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span style="background-color: cyan;"> </span> </span>Impetigo contagiosa (tanpa gelembung cairan, dengan krusta/keropeng/koreng)</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Impetigo krustosa hanya terdapat pada anak-anak, paling sering muncul di muka, yaitu di sekitar hidung dan mulut. Kelainan kulit berupa eritema dan vesikel yang cepat memecah sehingga penderita datang berobat yang terlihat adalah krusta tebal berwarna kuning seperti madu. Jika dilepaskan tampak erosi dibawahnya<img align="left" height="187" hspace="12" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.jpg" width="344" />. Jenis ini biasanya berawal dari luka warna merah pada wajah anak, dan paling sering di sekitar hidung dan mulut. Luka ini cepat pecah, berair dan bernanah, yang akhirnya membentuk kulit kering berwarna kecoklatan. Bekas impetigo ini bisa hilang dan tak menyebabkan kulit seperti parut. Luka ini bisa saja terasa gatal tapi tak terasa sakit. Impetigo jenis ini juga jarang menimbulkan demam pada anak, tapi ada kemungkinan menyebabkan pembengkakan kelenjar getah bening pada area yang terinfeksi. Dan karena impetigo sangat mudah menular, makanya jangan menyentuh atau menggaruk luka karena dapat menyebarkan infeksi ke bagian tubuh lainnya.</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">B</span>ullous impetigo (dengan gelembung berisi cairan)</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Impetigo jenis ini utamanya menyerang bayi dan anak di bawah usia 2 tahun. Namun ada pendapat lain yang mengatakan bahwa Impetigo bulosa terdapat pada anak dan juga pada orang dewasa, paling sering muncul di ketiak, dada, dan punggung. Kelainan kulit berupa eritema, vesikel, dan bula. Kadang-kadang waktu penderita datang berobat, vesikel atau bula telah pecah. Impetigo ini meski tak terasa sakit, tapi menyebabkan kulit melepuh berisi cairan. Bagian tubuh yang diserang seringkali badan, lengan dan kaki. Kulit di sekitar luka biasanya berwarna merah dan gatal tapi tak terasa sakit. Luka akibat infeksi ini dapat berubah menjadi koreng dan sembuhnya lebih lama ketimbang serangan impetigo jenis lain</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><img height="249" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image004.jpg" width="286" /></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">Et</span>iologi</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Impetigo disebabkan oleh Staphylococcus aureus atau Group A Beta Hemolitik Streptococcus (Streptococcus pyogenes). Staphylococcus merupakan pathogen primer pada impetigo bulosa dan ecthyma<i> </i>(Beheshti, 2:2007).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Staphylococcus merupakan bakteri sel gram positif dengan ukuran 1 µm, berbentuk bulat, biasanya tersusun dalam bentuk kluster yang tidak teratur, kokus tunggal, berpasangan, tetrad, dan berbentuk rantai juga bisa didapatkan. Staphylococcus dapat menyebabkan penyakit berkat kemampuannya mengadakan pembelahan dan menyebar luas ke dalam jaringan dan melalui produksi beberapa bahan ekstraseluler. Beberapa dari bahan tersebut adalah enzim dan yang lain berupa toksin meskipun fungsinya adalah sebagai enzim. Staphylococcus dapat menghasilkan katalase, koagulase, hyaluronidase, eksotoksin, lekosidin, toksin eksfoliatif, toksik sindrom syok toksik, dan enterotoksin. (Brooks, 317:2005).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Streptococcus merupakan bakteri gram positif berbentuk bulat, yang mempunyai karakteristik dapat berbentuk pasangan atau rantai selama pertumbuhannya. Lebih dari 20 produk ekstraseluler yang antigenic termasuk dalam grup A, (Streptococcus pyogenes) diantaranya adalah Streptokinase, streptodornase, hyaluronidase, eksotoksin pirogenik, disphosphopyridine nucleotidase, dan hemolisin (Brooks, 332:2005).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b>Patofisologi</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;">Infeksi <span lang="IN">Staphylococcus aureus atau Group A Beta Hemolitik Streptococcus</span> dimana kita ketahui bakteri-bakteri tersebut <span lang="IN">dapat menyebabkan penyakit berkat kemampuannya mengadakan pembelahan dan menyebar luas ke dalam jaringan dan melalui produksi beberapa bahan ekstraseluler. Beberapa dari bahan tersebut adalah enzim dan yang lain berupa toksin meskipun fungsinya adalah sebagai enzim. Staphylococcus dapat menghasilkan katalase, koagulase, hyaluronidase, eksotoksin, lekosidin, toksin eksfoliatif, toksik sindrom syok toksik, dan enterotoksin.</span><span lang="IN"> </span><span class="fullpost">Bakteri staph menghasilkan racun yang dapat menyebabkan impetigo menyebar ke area lainnya. Toxin ini menyerang protein yang membantu mengikat sel-sel kulit. Ketika protein ini rusak, bakteri akan sangat cepat menyebar.</span> Enzim yang dikeluarkan oleh Stap akan merusak struktur kulit dan adnya rasa gatal dapat menyebabkan terbentuknya lesi pada kulit. </div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="EN-GB">Rasa gatal dengan lesi awal berupa makula eritematosa berukuran 1-2 mm, kemudian berubah menjadi bula atau vesikel. </span>Pada Impetigo contagiosa Awalnya berupa warna kemerahan pada kulit (makula) atau papul (penonjolan padat dengan diameter <0,5cm) yang berukuran 2-5 mm. Lesi papul segera menjadi vesikel atau pustul (papula yang berwarna keruh/mengandung nanah/pus) yang mudah pecah dan menjadi papul dengan keropeng/koreng berwarna kunig madu dan lengket yang berukuran <2cm dengan kemerahan minimal atau tidak ada kemerahan disekelilingnya, <span lang="EN-GB">sekret seropurulen kuning kecoklatan yang kemudian mengering membentuk krusta yang berlapis-lapis. Krusta mudah dilepaskan, di bawah krusta terdapat daerah erosif yang mengeluarkan sekret, sehingga krusta akan kembali menebal. Sering krusta menyebar ke perifer dan menyembuh di bagian tengah. Kemudian pada </span>Bullous impetigo <span lang="EN-GB">bula yang timbul secara tiba tiba pada kulit yang sehat </span>dari plak (penonjolan datar di atas permukaan kulit) merah, berdiameter 1-5cm, pada daerah dalam dari alat gerak (daerah ekstensor)<span lang="EN-GB">, bervariasi dari miliar sampai lentikular dengan dinding yang tebal, dapat bertahan selama 2 sampai 3 hari. Bila pecah, dapat menimbulkan krusta yang berwarna coklat, datar dan tipis.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">E</span>pidemiologi</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Impetigo terjadi di seluruh Negara di dunia dan angka kejadiannya selalu meningkat dari tahun ke tahun. Di Amerika Serikat Impetigo merupakan 10% dari masalah kulit yang dijumpai pada klinik anak dan terbanyak pada daerah yang jauh lebih hangat, yaitu pada daerah tenggara Amerika (Provider synergies, 2:2007). Di Inggris kejadian impetigo pada anak sampai usia 4 tahun sebanyak 2,8% pertahun dan 1,6% pada anak usia 5-15 tahun. Sekitar 70% merupakan impetigo krustosa (Cole, 1:2007).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Pasien dapat lebih jauh menginfeksi dirinya sendiri atau orang lain setelah menggaruk lesi. Infeksi seringkali menyebar dengan cepat pada sekolah atau tempat penitipan anak atau juga pada tempat dengan hygiene buruk atau tempat tinggal yang padat penduduk (Cole, 1:2007).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN">Faktor Predisposisi</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify;">Adapun factor predisposisi dari impetigo yaitu :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Kontak langsung dengan pasien impetigo</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Kontak tidak langsung melalui handuk, selimut, atau pakaian pasien impetigo</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">C</span>uaca panas maupun kondisi lingkungan yang lembab</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Kegiatan/olahraga dengan kontak langsung antar kulit seperti gulat</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">P</span>asien dengan dermatitis, terutama dermatitis atopik</span><span lang="IN"> </span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 27pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(Sumber Beheshta, 2:2007).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">M</span>anifestasi Klinik</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">I</span>mpetigo Krustosa</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Tempat predileksi tersering pada impetigo krustosa adalah di wajah, terutama sekitar lubang hidung dan mulut, karena dianggap sumber infeksi dari daerah tersebut. Tempat lain yang mungkin terkena, yaitu anggota gerak (kecuali telapak tangan dan kaki), dan badan, tetapi umumnya terbatas, walaupun penyebaran luas dapat terjadi (Boediardja, 2005; Djuanda, 2005).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Biasanya mengenai anak yang belum sekolah. Gatal dan rasa tidak nyaman dapat terjadi, tetapi tidak disertai gejala konstitusi. Pembesaran kelenjar limfe regional lebih sering disebabkan oleh Streptococcus<i>.</i></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Kelainan kulit didahului oleh makula eritematus kecil, sekitar 1-2 mm. Kemudian segera terbentuk vesikel atau pustule yang mudah pecah dan meninggalkan erosi. Cairan serosa dan purulen akan membentuk krusta tebal berwarna kekuningan yang memberi gambaran karakteristik seperti madu (honey colour). Lesi akan melebar sampai 1-2 cm, disertai lesi satelit disekitarnya. Lesi tersebut akan bergabung membentuk daerah krustasi yang lebar. Eksudat dengan mudah menyebar secara autoinokulasi (Boediardja, 2005).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b><span style="background-color: cyan;">2.</span><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"><span style="background-color: cyan;"> </span> </span></b><b><span lang="IN">Impetigo Bulos</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Tempat predileksi tersering pada impetigo bulosa adalah di ketiak, dada, punggung. Sering bersama-sama dengan miliaria. Terdapat pada anak dan dewasa. Kelainan kulit berupa vesikel (gelembung berisi cairan dengan diameter 0,5cm) kurang dari 1 cm pada kulit yang utuh, dengan kulit sekitar normal atau kemerahan. Pada awalnya vesikel berisi cairan yang jernih yang berubah menjadi berwarna keruh. Atap dari bulla pecah dan meninggalkan gambaran “collarette” pada pinggirnya. Krusta “varnishlike” terbentuk pada bagian tengah yang jika disingkirkan memperlihatkan dasar yang merah dan basah. Bulla yang utuh jarang ditemukan karena sangat rapuh (Yayasan Orang Tua Peduli, 1:2008).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Bila impetigo menyertai kelainan kulit lainnya maka, kelainan itu dapat menyertai dermatitis atopi, varisela, gigitan binatang dan lain-lain. Lesi dapat lokal atau tersebar, seringkali di wajah atau tempat lain, seperti tempat yang lembab, lipatan kulit, ketiak atau lipatan leher. Tidak ada pembengkakan kelenjar getah bening di dekat lesi. (Yayasan Orang Tua Peduli, 1:2008).</span><span lang="IN"> </span><span lang="IN">Pada bayi, lesi yang luas dapat disertai dengan gejala demam, lemah, diare. Jarang sekali disetai dengan radang paru, infeksi sendi atau tulang. (Yayasan Orang Tua Peduli, 1:2008).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">P</span>emeriksaan Penunjang</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Bila diperlukan dapat memeriksa isi vesikel dengan pengecatan gram untuk menyingkirkan diagnosis banding dengan gangguan infeksi gram negative. Bisa dilanjutkan dengan tes katalase dan koagulase untuk membedakan antara Staphylococcus<i> </i>dan<i> </i>Streptococcus (Brooks, 332:2005).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">D</span>iagnosis Banding</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Dermatitis atopi: keluhan gatal yang berulang atau berlangsung lama (kronik) dan kulit kering; penebalan pada lipatan kulit terutama pada dewasa (likenifikasi); pada anak seringkali melibatkan daerah wajah atau tangan bagian dalam.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Candidiasis (infeksi jamur candida): papul merah, basah; umumnya di daerah selaput lender atau daerah lipatan.</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Dermatitis kontak: gatal pada daerah sensitive yang kontak dengan zat-zat yang mengiritasi.</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Di</span>skoid lupus eritematus: lesi datar(plak), batas tegas yang mengenai sampai folikel rambut.</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Ektima: lesi berkrusta yang menutupi daerah ulkus (luka dengan dasar dan dinding) dapat menetap selama beberapa minggu dan sembuh dengan jaringan parut bila infeksi sampai jaringan kulit dalam (dermis).</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Herpes simpleks: vesikel berkelompok dengan dasar kemerahan yang pecah menjadi lecet tertutupi oleh krusta, biasanya pada bibir dan kulit.</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Gi</span>gitan serangga: Terdapat papul pada daerah gigitan, dapat nyeri.</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN">Skabies: Papula yang kecil dan menyebar, terdapat terowongan pada sela-sela jari, gatal pada malam hari.</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18.65pt;"><span style="background-color: cyan;">9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">V</span>arisela: Vesikel pada dasar kemerahan bermula di badan dan menyebar ke tangan, kaki, dan wajah; vesikel pecah dan membentuk krusta; lesi terdapat pada beberapa tahap (vesikel, krusta) pada saat yang sama (Cole, 3:2007).</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">J.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">K</span>omplikasi</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span class="fullpost">Sebenarnya impetigo tidaklah berbahaya, tapi kadang infeksi ini menyebabkan komplikasi serius meski jarang terjadi, </span><span lang="IN">Impetigo biasanya sembuh tanpa penyulit dalam 2 minggu walaupun tidak diobati. Komplikasi berupa radang ginjal</span>/<b> </b><span class="fullpost">Poststreptococcal glomerulonephritis (PSGN)</span><span lang="IN"> pasca infeksi Streptococcus terjadi pada 1-5% pasien terutama usia 2-6 tahun dan hal ini tidak dipengaruhi oleh pengobatan antibiotic. Gejala berupa bengkak dan kenaikan tekanan darah, pada sepertiga terdapat urine seperti warna te</span>h<span lang="IN">. Keadaan ini umumnya sembuh secara spontan walaupun gejala-gejala tadi muncul (Yayasan Orang Tua Peduli, 4:2008).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Komplikasi lainnya yang jarang terjadi adalah infeksi tulang (osteomielitis), radang paru-paru (pneumonia), selulitis</span> (<span class="fullpost">merupakan infeksi serius yang menyerang jaringan di bawah kulit dan dapat menyebar ke kelenjar getah bening serta memasuki aliran darah, Jika tak ditangani, cellulitis dapat mengancam jiwa)</span><span lang="IN">, psoriasis, Staphylococcal scalded skin syndrome, radang pembuluh limfe atau kelenjar getah bening (Yayasan Orang Tua Peduli, 4:2008)</span> serta <span class="fullpost">Infeksi methicillin-resistant Staphylococcus aureus (MRSA), kulit parut berubah warna terang atau gelap</span><span lang="IN">.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">K.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">Pe</span>natalaksanaan</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: 27pt;"><span class="fullpost">Penanganan dini yang dapat dilakukan</span> oleh ibu jika mendapati anaknya dengan tanda dan gejala impetigo yaitu :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><span class="fullpost"><span style="background-color: cyan;">Ren</span>dam bagian kulit yang sakit dalam air sabun selama 15-20 menit. Lakukan 2-3 kali sehari untuk melunturkan kerak pada kulit.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><span class="fullpost"><span style="background-color: cyan;">G</span>unakan sabun obat seperti Betadin. Anda dapat membelinya di apotek. Gosoklah kulit sakit yang mengering.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><span class="fullpost"><span style="background-color: cyan;">O</span>leskan salep obat seperti polysporin pada kulit yang sakit. Lakukan 2-3 kali sehari setelah kerak pada kulit hilang. Anda dapat membeli polysporin di apotek.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><span class="fullpost">Tutup kulit yang sakit dengan perban yang bersih. Jangan biarkan anak menyentuh atau menggaruknya.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><span class="fullpost"><span style="background-color: cyan;">L</span>akukan beberapa hal berikut iniuntuk menghentikan penyebaran impetigo.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="background-color: cyan;">C</span>uci tangan Anda dengan sabun setelah menyentuh kulit anak Anda yang sakit atau pakaian maupun handuknya.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="background-color: cyan;">C</span>uci tangan anak Anda sampai bersih. Potong pendek kuku tangan anak Anda.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="background-color: cyan;">J</span>aga agar tangan anak Anda tidak menyentuh hidungnya.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="background-color: cyan;">S</span>impan pakaian, handuk, dan barang-barang anak Anda terpisah dengan anggota keluarga yang lain. Cucilah dengan sabun dan air panas.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><span class="fullpost"><span style="background-color: cyan;">Se</span>gera hubungi dokter jika:</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost">Menurut Anda anak Anda terjangkit ipetigo.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="background-color: cyan;">K</span>ulit yang sakit semakin meluas.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="background-color: cyan;">K</span>ulit yang sakit menjalar ke bagian tubuh yang lain.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="background-color: cyan;">A</span>nak Anda tampak sakit.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span class="fullpost"><span style="background-color: cyan;">An</span>ak Anda mengalami pembengkakan atau sakit pada persendian, termasuk siku dan lutut.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;">Ada pun terapi yang dapat diberikan dari segi perawtan yaitu :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Ter</span>api nonmedikamentosa</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18.15pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">M</span>enghilangkan krusta dengan cara mandikan anak selama 20-30 menit, disertai mengelupaskan krusta dengan handuk basah</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18.15pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">M</span>encegah anak untuk menggaruk daerah lecet. Dapat dengan menutup daerah yang lecet dengan perban tahan air dan memotong kuku anak</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18.15pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">La</span>njutkan pengobatan sampai semua luka lecet sembuh</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18.15pt;"><span style="background-color: cyan;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">La</span>kukan drainase pada bula dan pustule secara aseptic dengan jarum suntik untuk mencegah penyebaran local</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18.15pt;"><span style="background-color: cyan;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Dap</span>at dilakukan kompres dengan menggunakan larutan NaCl 0,9% pada impetigo krustosa.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18.15pt;"><span style="background-color: cyan;">f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Lak</span>ukan pencegahan seperti yang disebutkan pada point XI di bawah</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Tera</span>pi medikamentosa</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Te</span>rapi topikal</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Pengobatan topikal sebelum memberikan salep antibiotik sebaiknya krusta sedikit dilepaskan baru kemudian diberi salep antibiotik. Pada pengobatan topikal impetigo bulosa bisa dilakukan dengan pemberian antiseptik atau salap antibiotik (Djuanda, 57:2005).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">A</span>ntiseptik</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: 27pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Antiseptik yang dapat dijadikan pertimbangan dalam pengobatan impetigo terutama yang telah dilakukan penelitian di Indonesia khususnya Jember dengan menggunakan Methicillin Resistant Staphylococcus aureus (MRSA) adalah triklosan 2%. Pada hasil penelitian didapatkan jumlah koloni yang dapat tumbuh setelah kontak dengan triklosan 2% selama 30”, 60”, 90”, dan 120” adalah sebanyak 0 koloni (Suswati, 6:2003).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: 27pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sehingga dapat dikatakan bahwa triklosan 2%mampu untuk mengendalikan penyebaran penyakit akibat infeksi Staphylococcus aureus (Suswati, 6:2003).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 81pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">A</span>ntibiotik Topikal</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">M</span>upirocin</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Mupirocin topikal merupakan salah satu antibiotik yang sudah mulai digunakan sejak tahun 1980an. Mupirocin ini bekerja dengan menghambat sintesis RNA dan protein dari bakteri. Pada salah satu penelitian yang telah dilakukan dengan menggunakan mupirocin topikal yang dibandingkan dengan pemberian eritromisin oral pada pasien impetigo yang dilakukan di Ohio didapatkan hasil sebagai berikut:</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Pada tabel di atas dapat dilihat bahwa penggunaan mupirocin topikal jauh lebih unggul dalam mempercepat penyembuhan pasien impetigo, meskipun pada awal kunjungan diketahui lebih baik penggunaan eritromisin oral, namun pada akhir terapi dan pada evaluasi diketahui jauh lebih baik mupirocin topikal dibandingkan dengan eritromisin oral dan penggunaan mupirocin topikal memiliki sedikit failure<i> </i>(Goldfarb, 1-3).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">F</span>usidic Acid</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Tahun 2002 telah dilakukan penelitian terhadap fusidic acid yang dibandingkan dengan plasebo pada praktek dokter umum yang diberikan pada pasien impetigo</span>. <span lang="IN">dapat dilihat bahwa penggunaan plasebo jauh lebih baik dibandingkan dengan menggunakan fassidic acid.</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">R</span>atapamulin</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Pada tanggal 17 April 2007 ratapamulin telah disetujui oleh Food and Drug Administration (FDA) untuk digunakan sebagai pengobatan impetigo. Namun bukan untuk yang disebabkan oleh metisilin resisten ataupun vankomisin resisten. Ratapamulin berikatan dengan subunit 50S ribosom pada protein L3 dekat dengan peptidil transferase yang pada akhirnya akan menghambat protein sintesis dari bakteri (Buck, 1:2007). </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Pada salah satu penelitian yang telah dilakukan pada 210 pasien impetigo yang berusia diantara 9 sampai 73 tahun dengan luas lesi tidak lebih dari 100 cm2 atau >2% luas dari total luas badan. Kultur yang telah dilakukan pada pasien tersebut didapatkan 82% dengan infeksi Staphylococcus aureus. Pada pasien-pasien tersebut diberi ratapamulin sebanyak 2 kali sehari selama 5 hari terapi. Evaluasi dilakukan mulai hari ke dua setelah hari terakhir terapi, dan didapatkan luas lesi berkurang, lesi telah mengering, dan lesi benar-benar telah membaik tanpa penggunaan terapi tambahan. Pada 85,6% pasien dengan menggunakan ratapamulin didapatkan perbaikan klinis dan hanya hanya 52,1% pasien mengalami perbaikan klinis yang menggunakan plasebo (Buck, 1:2007).</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Di</span>cloxacillin</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: 27pt;"><span lang="IN">Penggunaan dicloxacillin merupaka First line untuk pengobatan impetigo, namun akhir-akhir ini penggunaan dicloxacillin mulai tergeser oleh penggunaan ratapamulin topikal karena diketahui ratapamulin memiliki lebih sedikit efek samping bila dibandingkan dengan dicloxacillin. Penggunaan dicloxacillin sebagai terapi topical pada impetigo sebagai berikut:</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: 27pt;"><span lang="IN">(Sumber: Primary Clinical Care Manual 2007)</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Te</span>rapi sistemik</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -14.15pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Pe</span>nisilin dan semisintetiknya (pilih salah satu)</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Penic</span>illin G procaine injeksi</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dosis: 0,6-1,2 juta IU im 1-2 x sehari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak: 25.000-50.000 IU im 1-2 x sehari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">A</span>mpicillin</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dosis: 250-500 mg per dosis 4 x sehari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak: 7,5-25 mg/Kg/dosis4x sehari ac</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Am</span>oksicillin</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dosis: 250-500 mg / dosis 3 x sehari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak: 7,5-25 mg/Kg/dosis 3 x sehari ac</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Cl</span>oxacillin (untuk Staphylococcus yang kebal penicillin)</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dosis: 250-500 mg/ dosis, 4 x sehari ac</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak: 10-25 mg/Kg/dosis 4 x sehari ac</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 94.5pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">e)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Phe</span>noxymethyl penicillin (penicillin V)</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dosis: 250-500 mg/dosis, 4 x sehari ac</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: 9.45pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak: 7,5-12,5 mg/Kg/dosis, 4 x sehari ac</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -14.15pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">E</span>ritromisin (bila alergi penisilin)</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: 4.5pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dosis: 250-500 mg/dosis, 4 x sehari pc</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: 4.5pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak: 12,5-50 mg/Kg/dosis, 4 x sehari pc</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -14.15pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Cl</span>indamisin (alergi penisilin dan menderita saluran cerna)</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: 4.5pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dosis: 150-300 mg/dosis, 3-4 x sehari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: 4.5pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anak > 1 bulan 8-20 mg/Kg/hari, 3-4 x sehari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify; text-indent: -14.15pt;"><span style="background-color: cyan; font-size: 10pt; line-height: 150%;">4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Pe</span>nggunaan terapi antibiotik sistemik lainnya </span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 76.5pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada penggunaan sistemik antibiotik lainnya yang dapat dipertimbangkan adalah, sebagai berikut:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">L.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span lang="IN"><span style="background-color: cyan;">Pen</span>cegahan</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify;"><span lang="IN">Tindakan yang bisa dilakukan guna pencegahan impetigo diantaranya</span> :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Cu</span>ci tangan segera dengan menggunakan air mengalir bila habis kontak dengan pasien, terutama apabila terkena luka.</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Jan</span>gan menggunakan pakaian yang sama dengan penderita</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Be</span>rsihkan dan lakukan desinfektan pada mainan yang mungkin bisa menularkan pada orang lain, setelah digunakan pasien</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Ma</span>ndi teratur dengan sabun dan air (sabun antiseptik dapat digunakan, namun dapat mengiritasi pada sebagian kulit orang yang kulit sensitif)</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Hig</span>iene yang baik, mencakup cuci tangan teratur, menjaga kuku jari tetap pendek dan bersih</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Ja</span>uhkan diri dari orang dengan impetigo</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">C</span>uci pakaian, handuk dan sprei dari anak dengan impetigo terpisah dari yang lainnya. Cuci dengan air panas dan keringkan di bawah sinar matahari atau pengering yang panas. Mainan yang dipakai dapat dicuci dengan disinfektan.</span><span lang="IN"> </span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN"><span style="background-color: cyan;">Gu</span>nakan sarung tangan saat mengoleskan antibiotik topikal di tempat yang terinfeksi dan cuci tangan setelah itu</span>. <span lang="IN">(Sumber: Northern Kentucky Health Department, 1:2005).</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify;"><b><span style="font-size: 12pt; line-height: 150%;">Prognosis </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada umumnya baik.</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KONSEP ASUHAN KEPERAWATAN</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Pe</span>ngkajian</b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">I</span>dentitas Penderita Dan Identita Orang Tua </b>(Mencakup<b>: </b>Nama, Jenis Kelamin, Umur, Suku, Agama, Pekerjaan, Alamat)</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Ke</span>luhan Utama. </b>Misalnya Luka garukan di regio lumbal posterior dekstra</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">R</span>iwayat Penyakit Sekarang.</b> Misalnya : Menurut Ibu pasien mulai 10 hari yang lalu pasien mengeluhkan gatal pada regio lumbal posterior dekstra, tanpa adanya keluhan gatal di daerah lain. Awalnya muncul vesikel, karena gatal, lalu digaruk oleh pasien kemudian vesikel pecah dan menimbulkan kerak. Vesikel-vesikel semakin lama semakin bertambah banyak dan menyebar. Pasien sudah dibawa berobat ke dokter, diberi salep dan tablet namun keluhan tidak berkurang. Akhirnya pasien berobat ke RSUD.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Riw</span>ayat Penyakit Dahulu</b>. Misalnya : Pasien tidak pernah menderita penyakit seperti ini sebelumnya.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">R</span>iwayat Penyakit Keluarga</b>. Ada atau tidak yang menderita penyakit yang sama dengan pasien.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Riw</span>ayat Pengobatan</b>. Tanyakan, apakah Pernah berobat ke dokter umum? Apakah keluhan berkurang setelah diberi obat?.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Riw</span>ayat Alergi</b>. Kaji apakah ada riwayat alergi makanan atau obat atau jenis alergi lainnya.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">P</span>EMERIKSAAN FISIK</b></div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">St</span>atus Generalis</b> </div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Kesadaran: komposmentis</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Keadaan Umum: baik</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Kepala/Leher: dalam batas normal</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Thorak</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Cor : S1S2 tunggal, lain-lain dalam batas normal</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Pulmo: Vesikuler, Rh-/-, Wh -/-, lain-lain dalam batas normal</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Abdomen: Soepel, bising usus (+), lain-lain dalam batas normal</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Ekstremitas: dalam batas normal</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Genitalia: dalam batas normal</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Sta</span>tus Lokalis</b> </div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: 9pt;">Lokasi : regio lumbal dekstra bagian posterior</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">Efloresensi : Pada pemeriksaan didapatkan lesi kulit berupa papula berisi cairan keruh, tidak dikelilingi daerah eritematus, selain itu juga ditemukan bekas bula yang pecah berupa kulit yang eritematus dengan krusta tipis kecoklatan pada bagian tepi.</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">D</span>iagnosa Keperawatan</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify;">Adapun diagnose keperawatan yang dapat jita angkat adalah :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">K</span>erusakan integritas kulit berhubungan dengan lesi dan cedera mekanik (garukan pada kulit yang gatal)</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Re</span>siko penyebaran infeksi berhubungan dengan Daya tahan tubuh menurun, malnutrisi, proses inflamasi, dan prosedur infasif</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ga</span>ngguan citra tubuh berhubungan dengan perubahan dalam penampilan sekunder</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">C</span>emas berhubungan dengan perubahan status kesehatan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ku</span>rang Pengetahuan mengenai penyakit, prognosis dan kebutuhan pengobatan.</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">R</span>encana Tindakan</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">D</span>x.I</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;">Setelah dilakukan tindakan asuhan keperawatan Selama ….x 24 jam diharapkan lapisan kulit klien terlihat normal, dengan KH :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Inte</span>gritas kulit yang bak dapat dipetahankan (sensasi, elastisitas, temperatur)</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Tid</span>ak ada luka atau lesi pada kulit</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">M</span>ampu melindungi kulit dan mempertahankan kelembapan kulit serta perawatan alami</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Perf</span>usi jaringan baik</div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana Tindakan</span></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Anjurk</span>an pasien menggunakan pakaian yang longgar</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">R : Baju yang longgar akan mengurangi gesekan baju pada kulit yang mengalami lesi</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Poto</span>ng kuku dan jaga kebersihan tangan klien</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">R : kuku yang pendek akan mengurangi garukan pada impetigo dan menghindari keparahan terjadinya lesi</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Jag</span>a kebersihan kulit agar tetap bersih dan kering</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">R : kulit yang bersih dan kering akan mengurangi penyebaran atau perkembangbiakan dari bakteri</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Mo</span>nitor kulit akan adanya kemerahan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">R : untuk mengetahui perkembangan penyakit dan keefektifan tindakan yang telah dilakukan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">M</span>andikan pasien dengan air hangat dan sabun (antiseptic)</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">R : air hangat akan mengurangi ruam dan membunuh bakteri. Sabun anti septic dapat mengurangi atau membunuh bakteri pada kulit.</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Kol</span>aborasi untuk pemberian antibiotic topical pada klien</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">R : antibiotic topical dapat memtus atau menghambat dari pertumbuhan bakteri stap dan kolaborasi dapat mmempercepat proses pemulihan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">j.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ber</span>ikan pengetahuan pada klien agar jangan menggaruk lukanya</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">R : pengetahuan pasien pada proses pengobatan dapat mempercepat keberhasilan proses keperawatan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Dx</span>.2</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;">Setelah dilakukan tindakan asuhan keperawatan selama …. X24jam diharapkan klien tidak terjadi resiko infeksi dengan KH :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Klien bebas dari tanda dan gejala infeksi</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">M</span>enunjukan kemampuan untuk mencegah timbulnya infeksi</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Me</span>nunjukkan perilaku hidup sehat</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">M</span>endeskripsikan proses penularan penyakit, factor yang mempengaruhi penularan </div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;"><b><u>Rencana Tindakan</u></b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">M</span>onitor tanda dan gejala infeksi</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">M</span>onitor kerentanan terhadap infeksi</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ba</span>tasi pengunjung bila perlu</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Instr</span>uksikan pada pengunjung untuk mencuci tangan saat berkunjung dan setelah meninggalkan pasien</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Pe</span>rtahankan lingkngan aseptic selama pengobatan berlangsung</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ber</span>ikan perawatan kulit pada area epidema</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">In</span>speksi kulit dan membrane mukosa terhadap kemerahan,panas</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">In</span>speksi kondisi luka</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Be</span>rikan terapi anibiotik bila perlu</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">j.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">A</span>jarkan cara menghindari infeksi</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">D</span>x. 3</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;">Setelah dilakukan tindakan asuhan keperawatan selama …. X24jam diharapkan klien tidak mengalami gangguan dalam cara penerapan citra diri dengan KH :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">m</span>engungkapan penerimaan atas penyakit yang di alaminya</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">m</span>engakui dan memantapkan kembali system dukungan yang ada</div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana Tindakan</span></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">D</span>orong individu untuk mengekspresian perasaan khususnya mengenai</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;"><span style="background-color: cyan;">pik</span>iran, pandangan dirinya</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Do</span>rong individu untuk bertanya mengenai masalah penanganan, perkembangan kesehatan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: -18pt;"><b style="background-color: cyan;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Dx.</span> 4</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;">Setelah dilakukan tindakan asuhan keperawatan selama …. X24jam diharapkan klien tidak cemas lagi dengan KH :</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Kl</span>ien tidak resah</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Kli</span>en tampak tenang dan mampu menerima kenyaataan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">KL</span>ien mampu mengidentifiasi dan mengungkapkan gejala cemas</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Po</span>stur tubuh ekspresi wajah, bahasa tubuh dan tingkat aktivitas menunjukkan bekurangnya kecemasan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify;">Rencana Tindakan </div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Iden</span>tifiasi kecemasan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Gunakan </span>pendekatan yang menenangan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Tem</span>ani pasien untuk memberian keamanan dan mengurangi takut</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ban</span>tu pasien mengenal situasi yang menimbulkan kecemasan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">B</span>erikan informasi faktual tentang diagnosis, tindakan prognosis</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Beri</span>kan obat untuk mengurangi kecamasan</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 63pt; text-align: justify; text-indent: -18pt;"><span style="background-color: cyan;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">D</span>x. 5</div><div class="MsoListParagraph" style="background-color: cyan; color: black; margin: 0cm 0cm 0.0001pt 63pt;">Pasien menunjukkan pemahaman akan proses penyakit dan prosedur perawatan dengan Kriteria: Dapat menjelaskan status penyakit, pengobatan, paham akan perawatan yang dilakukan.</div><div class="MsoListParagraph" style="background-color: cyan; color: black; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="background-color: cyan;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Aja</span>rkan Tentang Proses Penyakit</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Te</span>ntukan tingkat pengetahuan pasien dan keluarga yang berhubungan dengan proses penyakit.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Jelas</span>kan patofisiologi penyakit dan hubungankan dengan anatomi dan fisiologi.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">G</span>ambarkan tanda dan gejala penyakit.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ga</span>mbarkan proses penyakit.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;"> </span><span style="background-color: cyan;">Id</span>entifikasi penyebab yang mungkin.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Se</span>diakan informasi tentang kondisi pasien</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">7)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">B</span>erikan informasi tentang tindakan diagnostik.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">8)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ga</span>mbarkan rasionalitas dari terapi/perawatan yang diberikan.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">9)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Gam</span>barkan komplikasi.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">10)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">D</span>iskusikan tentang perubahan gaya hidup pada pasien yang mungkin dibutuhkan.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">11)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Dis</span>kusikan tentang pilihan terapi/perawatan.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">12)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Sedia</span>kan waktu untuk mengeksplorasi pendapat kedua</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">13)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ga</span>lisumber daya pendukung.</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">14)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">A</span>njurkan pasien dan keluarga untuk mengenali tanda gejala dan melaporkannya.</div><div class="MsoListParagraphCxSpLast" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 99pt; text-indent: -18pt;"><span style="background-color: cyan;">15)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Klar</span>ifikasi informasi yang diberikan oleh tim kesehatan lain sebelum informasi diberikan.</div><div class="MsoNormal" style="background-color: cyan; color: black; margin: 0cm 0cm 0.0001pt 63pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Rasional :</span></b></div><div class="MsoListParagraphCxSpFirst" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="background-color: cyan; font-family: Symbol;">ÿ<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Un</span>tuk memfasilitasi daerah klien dan penggunaan layanan kesehatan yang tepat</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="background-color: cyan; font-family: Symbol;">ÿ<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Me</span>mbantu klien dalam memahami informasi yang berhubungan dengan proses timbulnya penyakit secara khusus</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="background-color: cyan; font-family: Symbol;">ÿ<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Ag</span>ar klien mengetahui makanan apa saja yang dianjurkan</div><div class="MsoListParagraphCxSpMiddle" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="background-color: cyan; font-family: Symbol;">ÿ<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">A</span>gar klien memahami terhadap penanganan yang dilakukan / dianjurkan</div><div class="MsoListParagraphCxSpLast" style="background-color: cyan; color: black; line-height: 115%; margin: 0cm 0cm 0.0001pt 81pt; text-indent: -18pt;"><span style="background-color: cyan; font-family: Symbol;">ÿ<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Agar</span> klien mengalami aktivitas apa yang harus dilakukan</div><div style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Im</span>plementasi</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify; text-indent: 27pt;">Menurut Doenges (2000) implementasi adalah perawat mengimplementasikan intervensi-intervensi yang terdapat dalam rencana perawatan. Menurut Allen (1998) komponen dalam tahap implementasi meliputi tindakan keperawatann mandiri, kolaboratif, dokumentasi, dan respon pasien terhadap asuhan keperawatan. </div><div style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><b style="background-color: cyan;">E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b><b><span style="background-color: cyan;">Evalu</span>asi</b></div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 45pt; text-align: justify;">Evaluasi didasarkan pada kemajuan pasien dalam mencapai hasil akhir yang ditetapkan yaitu meliputi ; kesejahteraan fisik ibu dan bayi akan dipertahankan. Ibu dan keluarga akan mengembangkan koping yang efektif. Setiap anggota keluarga akan melanjutkan pertumbuhan dan perkembangan yang sehat. Perawat dapat yakin bahwa perawatan berlangsung efektif jika kesejahteraan fisik ibu dan bayi dapat dipertahankan, ibu dan keluarganya dapat mengatasi masalahnya secara efektif, dan setiap anggota keluarga dapat meneruskan pola pertumbuhan dan perkembangan yang sehat<span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"></span> </div><span style="background-color: cyan; color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span> <table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="background-color: cyan; color: black; width: 100%;"><tbody>
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</div><div class="MsoListParagraph" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: -21.3pt;"><span style="background-color: cyan;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="background-color: cyan;">Imp</span>etigo adalah infeksi kulit yang disebabkan oleh Stafilokokus aureus, Streptokokus grup A, atau kombinasi keduanya.</div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: -21.3pt;"><span style="background-color: cyan; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="background-color: cyan;">Ad</span>a 2 jenis impetigo yaitu impetigo bulosa dan impetigo non-bulosa.</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: -21.3pt;"><span style="background-color: cyan; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="background-color: cyan;">Pe</span>ngobatan impetigo adalah dengan antibiotik (dapat berupa salep atau antibiotik oral).</span></div><div class="MsoNormal" style="background-color: cyan; color: black; line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: -21.3pt;"><span style="background-color: cyan; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="background-color: cyan;">M</span>enjaga kebersihan tubuh merupakan cara terbaik untuk mencegah terjadinya impetigo pada anak.</span></div>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-12719892617452022292011-02-19T03:58:00.001-08:002011-02-19T03:58:35.401-08:00Askep Scabies<!--[if !mso]> <style>
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</style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="3074"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> <o:rules v:ext="edit"> <o:r id="V:Rule1" type="connector" idref="#_x0000_s1028"/> <o:r id="V:Rule2" type="connector" idref="#_x0000_s1029"/> <o:r id="V:Rule3" type="connector" idref="#_x0000_s1035"/> <o:r id="V:Rule4" type="connector" idref="#_x0000_s1034"/> <o:r id="V:Rule5" type="connector" idref="#_x0000_s1032"/> <o:r id="V:Rule6" type="connector" idref="#_x0000_s1031"/> <o:r id="V:Rule7" type="connector" idref="#_x0000_s1033"/> <o:r id="V:Rule8" type="connector" idref="#_x0000_s1026"/> <o:r id="V:Rule9" type="connector" idref="#_x0000_s1027"/> <o:r id="V:Rule10" type="connector" idref="#_x0000_s1030"/> </o:rules> </o:shapelayout></xml><![endif]--> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I<br />
PENDAHULUAN<br />
<br />
</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang<span></span></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies adalah penyakit kulit yang disebabkan oleh infestisasi dan sensitisasi terhadap sarcoptes scabiei varian hominis dan produknya. Sinnim dari penyakit ini adalah kudis, the itch, gudig, budukan, dan gatal agogo.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit scabies ini merupakan penyakit menular oleh kutu tuma gatal sarcoptes scabei tersebut, kutu tersebut memasuki kulit stratum korneum, membentuk kanalikuli atau terowongan lurus atau berkelok sepanjang 0,6 sampai 1,2 centimeter.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Akibatnya, penyakit ini menimbulkan rasa gatal yang panas dan edema yang disebabkan oleh garukan. Kutu betina dan jantan berbeda. Kutu betina panjangnya 0,3 sampai 0,4 milimeter dengan empat pasang kaki, dua pasang di depan dengan ujung alat penghisap dan sisanya di belakang berupa alat tajam. Sedangkan, untuk kutu jantan, memiliki ukuran setengah dari betinanya. Dia akan mati setelah kawin. Bila kutu itu membuat terowongan dalam kulit, tak pernah membuat jalur yang bercabang.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Syarat obat yang ideal adalah efektif terhadap semua stadium tungau, tidak menimbulkan iritasi dan toksik, tidak berbau atau kotor, tidak merusak atau mewarnai pakaian, mudah diperoleh dan harganya murah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Permasalahan <span></span></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berdasarkan latar belakang di atas, maka kami selaku penulis mengangkat beberapa permasalahan, yaitu bagaimana konsep dasar dan konsep keperawatan pada klien dengan scabies, khususnya pada anak?</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan dari pembuatan makalah ini adalah untuk membahas konsep dasar dari scabies dan mengetahui proses keperawatan pada klien dengan scabies.<a href="" name="more"></a></span></div><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></b> <div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II<br />
KONSEP DASAR SCABIES</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Definisi</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Scabies<span> </span>merupakan penyakit kulit menular yang disebabkan oleh seekor tungau (kutu/<i>mite</i>) yang bernama <i>Sarcoptes scabei</i>, filum <i>Arthopoda</i> , kelas <i>Arachnida</i>, ordo <i>Ackarina</i>, superfamili <i>Sarcoptes</i>. Pada manusia oleh <i>S. scabiei var homonis</i>, pada babi oleh <i>S. scabiei var suis</i>, pada kambing oleh <i>S. scabiei var caprae</i>, pada biri-biri oleh <i>S. scabiei var ovis</i>.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><br />
<span> </span></span><span style="color: black;"><img height="255" src="file:///C:/DOCUME%7E1/HEAVEN%27S/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.jpg" width="166" /></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit scabies ini merupakan penyakit menular oleh kutu tuma gatal <i>Sarcoptes scabei</i>, kutu tersebut memasuki kulit stratum korneum, membentuk kanalikuli atau terowongan lurus atau berkelok sepanj</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ang 0,6 sampai 1,2 centimeter.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecil ukurannya, hanya bisa dilihat dibawah lensa mikroskop, yang hidup didalam jaringan kulit penderita, hidup membuat terowongan yang bentuknya memanjang dimalam hari. Itu sebabnya rasa gatal makin menjadi-jadi dimalam hari, sehingga membuat orang sulit tidur. Dibandingkan penyakit kulit gatal lainnya, scabies merupakan penyakit kulit dengan rasa gatal yang lebih dibandingkan dengan penyakit kulit lain.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sinonim dari penyakit ini adalah kudis, the itch, gudig, budukan, dan gatal agogo.<span> </span>Akibatnya, penyakit ini menimbulkan rasa gatal yang panas dan edema yang disebabkan oleh garukan. Kutu betina dan jantan berbeda. Kutu betina panjangnya 0,3 sampai 0,4 milimeter dengan empat pasang kaki, dua pasang di depan dengan ujung alat penghisap dan sisanya di belakang berupa alat tajam. Sedangkan, untuk kutu jantan, memiliki ukuran setengah dari betinanya. Dia akan mati setelah kawin. Bila kutu itu membuat terowongan dalam kulit, tak pernah membuat jalur yang bercabang.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di dalam terowongan ini, kutu bersarang dan mengeluarkan telurnya. Dalam waktu tujuh sampai 14 hari, telur menetas dan membentuk larva yang dapat berubah menjadi nimfa, selanjutnya terbentuk parasit dewasa. Hal yang paling disukai kutu betina adalah bagian kulit yang tipis dan lembab, yaitu daerah sekitar sela jari longlegs dan tangan, siku, pergelangan tangan, bahu, dan daerah kemaluan. Pada bayi yang memiliki kulit serba tipis, telapak tangan, kaki, muka, dan kulit kepala sering diserang kutu tersebut.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor penunjang penyakit ini antara lain social ekonomi rendah, hygiene buruk, sering berganti pasangan seksual, kesalahan diagnosis, dan perkembangan demografis serta ekologik. Penularan penyakit skabies inidapat terjadi scara langsung maupun tidak langsung, karenanya tak heran jika penyakit gudik (skabies) dapat dijumpai di sebuah keluarga, di kelas sekolah, di asrama, di pesantren. </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black;">Etiologi</span></b><span style="color: black;"></span></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black;">Scabies dapat disebabkan oleh kutu atau kuman <i>Sercoptes scabei</i> varian hominis. Sarcoptes scabieiini termasuk filum Arthopoda, kelas Arachnida, ordo Ackarina, superfamili Sarcoptes. Pada manusia disebut <i>Sarcoptes scabiei var</i> <i>hominis</i>. Kecuali itu terdapat S. scabiei yang lainnya pada kambing dan babi. Secara morfologik merupakan tungau kecil, berbentuk oval, punggungnya cembung dan bagian perutnya rata. Tungau ini transient, berwarna putih kotor, dan tidak bermata. Ukurannya yang betina berkisar antara 330-450 mikron x 250-350 mikron, sedangkan yang jantan lebih kecil, yakni 200-240 mikron x 150-200 mikron. Bentuk dewasa mempunyai 4 pasang kaki, 2pasang longlegs di depan sebagai alat alat untuk melekat dan 2pasang longlegs kedua pada betina berakhir dengan rambut, sedangkan pada yang jantan pasangan longlegs ketiga berakhir dengan rambut dan keempat berakhir dengan alat perekat. Siklus hidup tungau ini sebagai berikut. Setelah kopulasi (perkawinan) yang terjadi di atas kulit, yang jantan akan mati, kadang-kadang masih dapat hidup dalam terowongan yang digali oleh yang betina. Tungau betina yang telah dibuahi menggali terowongan dalam stratum korneum, dengan kecepatan 2-3 milimeter sehari dan sambil meletakkan telurnya 2 atau 4 butir sehari sampai mencapai jumlah 40 atau 50. Bentuk betina yang telah dibuahi ini dapat hidup sebulan lamanya. Telurnya akan menetas, biasanya dalam waktu 3-5 hari, dan menjadi larva yang mempunyai 3 pasang kaki. Larva ini dapat tinggal dalam terowongan, tetapi dapat juga keluar. Setelah 2-3 hari larva akan menjadi nimfa yang mempunyai 2 bentuk, jantan dan betina, dengan 4 pasang kaki. Seluruh siklus hidupnya mulai dari telur sampai bentuk dewasa memerlukan waktu antara 8-12 hari. Telur menetas menjadi larva dalam waktu 3-4 hari, kemudian larva meninggalkan terowongan dan masuk ke dalam folikel rambut. Selanjutnya larva berubah menjadi nimfa yang akan menjadi parasit dewasa. Tungau betina akan mati setelah meninggalkan telur, sedangkan tungau jantan mati setelah kopulasi. Sarcoptes scabiei betina dapat hidup diluar pada suhu kamar selama lebih kurang 7-14 hari.Yang diserang adalah bagian kulit yang tipis dan lembab, contohnya lipatan kulit pada orang dewasa. Pada bayi, karena seluruh kulitnya masih tipis, maka seluruh badan dapat terserang penyakit skabies ini.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengklasifikasian Skabies</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat beberapa bentuk skabies atipik yang jarang ditemukan dan sulit dikenal, sehingga dapat menimbulkan kesalahan diagnosis. Beberapa bentuk tersebut antara lain (Sungkar, S, 1995):</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies pada orang bersih (scabies of cultivated). Bentuk ini ditandai dengan lesi berupa papul dan terowongan yang sedikit jumlahnya sehingga sangat sukar ditemukan. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies incognito. Bentuk ini timbul pada scabies yang diobati dengan kortikosteroid sehingga gejala dan tanda klinis membaik, tetapi tungau tetap ada dan penularan masih bisa terjadi. Skabies incognito sering juga menunjukkan gejala klinis yang tidak biasa, distribusi atipik, lesi luas dan mirip penyakit lain. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies nodular. Pada bentuk ini lesi berupa nodus coklat kemerahan yang gatal. Nodus biasanya terdapat didaerah tertutup, terutama pada genitalia laki-laki, inguinal dan aksila. Nodus ini timbul sebagai reaksi hipersensetivitas terhadap tungau scabies. Pada nodus yang berumur lebih dari satu bulan tungau jarang ditemukan. Nodus mungkin dapat menetap selama beberapa bulan sampai satu tahun meskipun telah diberi pengobatan anti scabies dan kortikosteroid. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies yang ditularkan melalui hewan. Di Amerika, sumber utama skabies adalah anjing. Kelainan ini berbeda dengan skabies manusia yaitu tidak terdapat terowongan, tidak menyerang sela jari dan genitalia eksterna. Lesi biasanya terdapat pada daerah dimana orang sering kontak/memeluk binatang kesayangannya yaitu paha,<br />
perut, dada dan lengan. Masa inkubasi lebih pendek dan transmisi lebih mudah. Kelainan ini bersifat sementara (4 – 8 minggu) dan dapat sembuh sendiri karena S. scabiei var. binatang tidak dapat melanjutkan siklus hidupnya pada manusia.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies Norwegia. Skabies Norwegia atau skabies krustosa ditandai oleh lesi yang luas dengan krusta, skuama generalisata dan hyperkeratosis yang tebal. Tempat predileksi biasanya kulit kepala yang berambut, telinga bokong, siku, lutut, telapak tangan dan kaki yang dapat disertai distrofi kuku. Berbeda dengan scabies biasa, rasa gatal pada penderita skabies Norwegia tidak menonjol tetapi bentuk ini sangat menular karena jumlah tungau yang menginfestasi sangat banyak (ribuan). Skabies Norwegia terjadi akibat defisiensi imunologik sehingga sistem imun tubuh gagal membatasi proliferasi tungau dapat berkembangbiak dengan mudah. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies pada bayi dan anak. Lesi skabies pada anak dapat mengenai seluruh tubuh, termasuk seluruh kepala, leher, telapak tangan, telapak kaki, dan sering terjadi infeksi sekunder berupa impetigo, ektima sehingga terowongan jarang ditemukan. Pada bayi, lesi di muka. (Harahap. M, 2000). </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Skabies terbaring ditempat tidur (bed ridden). Penderita penyakit kronis dan orang tua yang terpaksa harus tinggal ditempat tidur dapat menderita skabies yang lesinya terbatas. (Harahap. M, 2000).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi Klinis</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosis dibuat dengan menemukan 2 dari 4 tanda cardinal berikut :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pruritus noktuma (gatal pada malam hari) karena aktivitas tungau lebih tinggi pada suhu yang lembab dan panas.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Umumnya ditemukan pada sekelompok manusia, misalnya mengenai seliruh anggota keluarga.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanya terowongan (kunikulus) pada tempat-tempat predileksi yang berwarna putih atau keabu-abuan, berbentuk garis lurus atau berkelok, rata-rata panjang 1cm, pada uung menjadi pimorfi (pustu, ekskoriosi). Tempat predileksi biasanya daerah dengan stratum komeum tpis, yaitu sela-sela jari tangan, pergelangan tangan bagian volar, siku bagian luar, lipat ketiak bagian depan, aerola mammae dan lipat glutea, umbilicus, bokong, genitalia eksterna, dan perut bagian bawah. Pada bayi dapat menyerang bagian telapak tangan dan telapak kaki bahkan seluruh permukaan ulit. Pada remaja dan orang dewasa dapat timbul pada kulit kepala dan wajah.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menemukan tungau merupakan hal yang paling diagnostk. Dapat ditemikan satu atau lebih stadium hidup tungau ini.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pasien yang selalu menjaga hygiene, lesi yang timbul hanya sedikit sehingga diagnosis kadang kala sulit ditegakkan. Jia penyakit berlangsung lama, dapat timbul likenifikasi, impetigo, dan furunkulsis.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patofisiologi Skabies</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan kulit dapat disebabkan tidak hanya dari tungau scabies, akan tetapi juga oleh penderita sendiri akibat garukan. Dan karena bersalaman atau bergandengan sehingga terjadi kontak kulit yang kuat, menyebabkan lesi timbul pada pergelangan tangan. Gatal yang terjadi disebabkan leh sensitisasi terhadap secret dan ekskret tungau yang memerlukan waktu kira-kira sebulan setelah infestasi. Pada saat itu kelainan kulit menyerupai dermatitis dengan ditemuannya papul, vesikel, dan urtika. Dengan garukan dapat timbul erosi, ekskoriasi, krusta, dan infeksi sekunder. Kelainan kulit dan gatal yang terjadi dapat lebih luas dari lokasi tungau.</span></div><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></b><br />
<div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="height: 24px; left: 0px; margin-left: 329px; margin-top: 524px; position: absolute; width: 12px; z-index: 10;"></span><span style="height: 24px; left: 0px; margin-left: 329px; margin-top: 468px; position: absolute; width: 12px; z-index: 8;"></span><span style="height: 21px; left: 0px; margin-left: 329px; margin-top: 27px; position: absolute; width: 12px; z-index: 1;"></span><span style="height: 24px; left: 0px; margin-left: 330px; margin-top: 420px; position: absolute; width: 12px; z-index: 9;"></span><span style="height: 24px; left: 0px; margin-left: 330px; margin-top: 366px; position: absolute; width: 12px; z-index: 7;"></span><span style="height: 24px; left: 0px; margin-left: 330px; margin-top: 141px; position: absolute; width: 12px; z-index: 3;"></span><span style="height: 24px; left: 0px; margin-left: 329px; margin-top: 197px; position: absolute; width: 12px; z-index: 4;"></span><span style="height: 24px; left: 0px; margin-left: 329px; margin-top: 258px; position: absolute; width: 12px; z-index: 5;"></span><span style="height: 24px; left: 0px; margin-left: 329px; margin-top: 312px; position: absolute; width: 12px; z-index: 6;"></span><span style="height: 24px; left: 0px; margin-left: 329px; margin-top: 76px; position: absolute; width: 12px; z-index: 2;"></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tungau scabies penderita sendiri dan digaruk<br />
<br />
Kontak kulit kuat<br />
<br />
Bersalaman bergandengan<br />
<br />
Timbul lesi<br />
<br />
Pergelangan tangan<br />
<br />
Gatal<br />
<br />
Sensitivitas terhadap secret<br />
<br />
Waktu 1 bulan setelah infestasi<br />
<br />
Timbul papul,vesikel,urtika timbul erosi,eks koriosi, krusta<br />
<br />
Digaruk infeksi skunder<br />
<br />
Kelainan kulit dermatitis menyebar luas<br />
<br />
</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Penunjang</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cara menemukan tungau :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Carilah mula-mula terowongan, kemudian pada ujung dapat terlihat papul atau vesiel. Congkel dengan jarum dan letakkan diatas kaca obyek, lalu tutup dengan aca penutup dan lhat dengan mikroskop cahaya.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dengan cara menyikat dengan siat dan ditampung diatas selembar kertas putih dan dilihat dengan kaca pembesar.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dengan membuat bipsi irisan, caranya ; jepit lesidengan 2 jari kemudian buat irisa tipis dengan pisau dan periksa dengan miroskop cahaya.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dengan biopsy eksisional dan diperiska dengan pewarnaan HE.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Syarat obat yang ideal adalah efektif terhadap semua stadium tungau, tidak menimbulkan iritasi dan toksik, tidak berbau atau kotor, tidak merusak atau mewarnai pakaian, mudah diperoleh dan harganya murah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><b><i><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis obat topical</span></i></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Belerang endap (sulfur presipitatum) 4-20% dalam bentuk salep atau krim. Pada bayi dan orang dewasa sulfur presipitatum 5% dalam minyak sangat aman dan efektif. Kekurangannya adalah pemakaian tidak boleh kurang dari 3 hari karena tidak efektif terhadap stadium telur, berbau, mengotori pakaian dan dapat menimbulkan iritasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Emulsi benzyl-benzoat 20-25% efektif terhadap semua stadium, diberikan setiap malam selama 3 kali. Obat ini sulit diperoleh, sering memberi iritasi, dan kadang-kadang makin gatal setelah dipakai.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gama benzena heksa klorida (gameksan) 1% daam bentuk krim atau losio, termasuk obat pilihan arena efektif terhadap semua stadium, mudah digunakan, dan jarang memberi iritasi. Obat ini tidak dianurkan pada anak dibawah umur 6 tahun dan wanta hamil karena toksi terhadap susunan saraf pusat. Pemberiannya cup sekali dalam 8 jam. Jika masihada gejala, diulangi seminggu kemudian.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Krokamiton 10% dalamkrim atau losio mempunyaidua efek sebagai antiskabies dan antigatal. Harus dijauhkan dari mata, mulut, dan uretra. Krim( eurax) hanya efetif pada 50-60% pasien. Digunakan selama 2 malam berturut-turut dan dbersihkan setelah 24 jam pemakaian terakhir.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Krim permetrin 5% merupakan obat yang paling efektif dan aman arena sangat mematikan untuk parasit S.scabei dan memiliki toksisitas rendah pada manusia.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemberian antibitika dapat digunakan jika ada infeksi sekunder, misalnya bernanah di area yang terkena (sela-sela jari, alat kelamin) akibat garukan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PROSES KEPERAWATAN</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biodata</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas pasien</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas orang tua</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluhan utama<br />
Pada pasien scabies terdapat lesi dikulit bagian punggung dan merasakan gatal terutama pada malam hari.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan sekarang<br />
Pasien mulai merasakan gatal yang memanas dan kemudian menjadi edema karena garukan akibat rasa gatal yang sangat hebat.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan dahulu<br />
Pasien pernah masuk RS karena alergi.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan keluarga<br />
Dalam keluarga pasien ada yang menderita penyakit seperti yang klien alami yaitu kurap, kudis.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola fungsi kesehatan</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola persepsi terhadap kesehatan<br />
Apabila sakit, klien biasa membeliobat di tko obat terdeat atauapabila tidak terjadi perubahan pasien memaksakan diri ke puskesmas atau RS terdekat.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola aktivitas latihan<br />
Aktivitas latihan selama sakit : </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aktivitas 0 1 2 3 4</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Makan</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mandi</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berpakaian</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Eliminasi</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mobilisasi di tempat tidur</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keterangan<br />
0 : Mandiri<br />
1 : Dengan menggunakan alat bantu<br />
2 : Dengan menggunakan bantuan dari orang lain<br />
3 : Dengan bantuan orang lain dan alat bantu<br />
4 : Tergantung total, tidak berpartisipasi dalam beraktivitas</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pola istirahat tidur<br />
Pada pasien scabies terjadi gangguan pola tidur akibat gatal yang hebat pada malam hari.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola nutrisi metabolik<br />
Tidak ada gangguan dalam nutrisi metaboliknya.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola elimnesi<br />
Klien BAB 1x sehari, dengan konsitensi lembek, wrna kuning bau khas dan BAK 4-5x sehari, dengan bau khas warna kuning jernih.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola kognitif perceptual<br />
Saat pengkajian kien dalam keadaan sadar, bicara jelas, pendengaran dan penglihatan normal.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola peran hubungan : </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem dukungan orang tua.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola konsep diri</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola seksual reproduksi<br />
Pada klien scabies mengalami gangguan pada seksual reproduksinya.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>j.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola koping</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Masalah utama yang terjadi selama klien sakit, klien selalu merasa gatal, dan pasien menjadi malas untuk bekerja.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kehilangan atau perubahan yang terjadi <span> </span>klien malas untuk melakukan aktivitas sehari-hari.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri akut berhubungan dengan agen cidera biologi.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pola tidur berhubungan dengan rasa gatal yang hebat khususnya pada malam hari.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan citra tubuh berhubungan dengan perubahan dalam penampilan.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ansietas <span> </span>berhubungan dengan perubahan status kesehatan.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan integritas kulit berhubungan dengan edema.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko infeksi<span> </span>dengan factor risiko:</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jaringan kulit rusak </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prosedur infasif</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><b>Rencana</b> <b>Intervensi<span> </span></b><br />
<b>Dx 1</b>: Nyeri akut berhubungan dengan agen cidera biologi.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span>Setelah dilakukan tindakan asuhan keperawatan diharapkan nyeri klien dapat teratasi dengan<br />
<b>KH</b>:</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri terkontrol</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gatal mulai hilang</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Puss hilang</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kulit tidak memerah <span> </span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 35.45pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kaji intensitas nyeri, karakteristik dan catat lokasi.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan perawatan kulit dengan sering, hilangkan rangsangan lingkungan yang kurang menyenangkan.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan dokter untuk pemberian analgesic.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 2cm; text-indent: -21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kolaborasi pemberian antibiotika.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx 2</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Gangguan pola tidur berhubungan dengan rasa gatal yang hebat khususnya pada malam hari.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span>Setelah dilakukan tindakan asuhan keperawatan diharapkan tidur klien tidak terganggu.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KH </span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mata klien tidak bengkak lagi.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien tidak sering terbangun di malam hari.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien tidak pucat.</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kaji tidur klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan kenyamanan pada klien (kebersihan tempat tidur klien)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan dokter pemberian analgetic.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Catat banyaknya klien terbangun dimalam hari.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan lingkungan yang nyaman dan kurangi kebisingan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan minum hangat (susu) jika perlu.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan musik klasik sebagai pengantar tidur</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx 3</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Gangguan citra tubuh berhubungan dengan perubahan dalam penampilan.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Setelah dilakukan tindakan asuhan keperawatan diharapkan klien tidak mengalami gangguan dalam cara penerapan citra diri.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KH</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengungkapkan penerimaan atas penyakit yang di alaminya.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengakui dan memantapkan kembali system dukungan yang ada.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dorong individu untuk mengekspresian perasaan khususnya mengenai pikiran, pandangan dirinya.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dorong individu untuk bertanya mengenai masalah penanganan, perkembangan kesehatan.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx 4</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Ansietas<span> </span>berhubungan dengan perubahan status kesehatan.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Setelah dilakukan tindakan asuhan keperawatan diharapkan klien tidak cemas lagi.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>KH :</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien tidak resah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien tampak tenang dan mampu menerima kenyaataan</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien mampu mengidentifiasi dan mengungkapkan gejala cemas</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifiasi kecemasan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gunakan pendekatan yang menyenangkan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Temani pasien untuk memberian keamanan dan mengurangi takut.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bantu pasien mengenal situasi yang menimbulkan kecemasan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan informasi faktual tentang diagnosis, tindakan prognosis.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan obat untuk mengurangi kecamasan</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx 5 : </span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kerusakan integritas kulit berhubungan dengan edema.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : Setelah dilakukan tindakan asuhan keperawatan diharapkan lapisan kulit klien terlihat normal.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KH :</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Integritas kulit yang baik dapat dipetahankan (sensasi, elastisitas, temperatur).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ada luka atau lesi pada kulit.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu melindungi kulit dan mempertahankan kelembapan kulit serta perawatan alami.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perfusi jaringan baik .</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan pasien menggunakan pakaian yang longgar.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Jaga kebersihan kulit agar tetap bersih dan kering.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor kulit akan adanya kemerahan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mandikan pasien dengan air hangat dan sabun</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dx 6 : </span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko infeksi<span> </span>dengan factor risiko:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 78pt; text-indent: -21.3pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jaringan kulit rusak </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 78pt; text-indent: -21.3pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prosedur infasif</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span>Setelah dilakukan tindakan asuhan keperawatan diharapkan klien tidak terjadi resiko infeksi.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KH :</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien bebas dari tanda dan gejala infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan kemampuan untuk mencegah timbulnya infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukkan perilaku hidup sehat.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mendeskripsikan proses penularan penyakit, factor yang mempengaruhi penularan dan penatalaksanaannya.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor tanda dan gejala infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Monitor kerentanan terhadap infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Batasi pengunjung bila perlu.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Instruksikan pada pengunjung untuk mencuci tangan saat berkunjung dan setelah meninggalkan pasien.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertahankan lingkngan aseptic selama pemasangan alat.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan perawatan kulit pada area epidema.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Inspeksi kulit dan membrane mukosa terhadap kemerahan, panas.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Inspeksi kondisi luka</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan terapi anibiotik bila perlu.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-indent: -18pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>10.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ajarkan cara menghindari infeksi.<br />
<br />
</span></div><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB IV<br />
PENUTUP</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: -21.3pt;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesimpulan</span></b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit scabies ini merupakan penyakit menular oleh kutu tuma gatal sarcoptes scabei tersebut, kutu tersebut memasuki kulit stratum korneum, membentuk kanalikuli atau terowongan lurus atau berkelok sepanjang 0,6 sampai 1,2 centimeter.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Akibatnya, penyakit ini menimbulkan rasa gatal yang panas dan edema yang disebabkan oleh garukan. Kutu betina dan jantan berbeda. Kutu betina panjangnya 0,3 sampai 0,4 milimeter dengan empat pasang kaki, dua pasang di depan dengan ujung alat penghisap dan sisanya di belakang berupa alat tajam. Sedangkan, untuk kutu jantan, memiliki ukuran setengah dari betinanya. Dia akan mati setelah kawin. Bila kutu itu membuat terowongan dalam kulit, tak pernah membuat jalur yang bercabang.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Syarat obat yang ideal adalah efektif terhadap semua stadium tungau, tidak menimbulkan iritasi dan toksik, tidak berbau atau kotor, tidak merusak atau mewarnai pakaian, mudah diperoleh dan harganya murah.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-17045807263602403752011-02-19T03:48:00.000-08:002011-02-19T03:48:06.175-08:00Askep Diaper Rash<!--[if !mso]> <style>
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</style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="2050"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> <o:rules v:ext="edit"> <o:r id="V:Rule1" type="connector" idref="#_x0000_s1027"/> <o:r id="V:Rule2" type="connector" idref="#_x0000_s1036"/> <o:r id="V:Rule3" type="connector" idref="#_x0000_s1030"/> <o:r id="V:Rule4" type="connector" idref="#_x0000_s1028"/> <o:r id="V:Rule5" type="connector" idref="#_x0000_s1026"/> <o:r id="V:Rule6" type="connector" idref="#_x0000_s1029"/> <o:r id="V:Rule7" type="connector" idref="#_x0000_s1037"/> <o:r id="V:Rule8" type="connector" idref="#_x0000_s1032"/> <o:r id="V:Rule9" type="connector" idref="#_x0000_s1035"/> <o:r id="V:Rule10" type="connector" idref="#_x0000_s1033"/> <o:r id="V:Rule11" type="connector" idref="#_x0000_s1031"/> <o:r id="V:Rule12" type="connector" idref="#_x0000_s1034"/> </o:rules> </o:shapelayout></xml><![endif]--> <div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN</span></b></div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar <span> </span>Belakang</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ruam popok adalah iritasi pada kulit bayi Ibu di daerah pantat. Ini bisa terjadi jika ia popok basahnya telat diganti, popoknya terlalu kasar dan tidak menyerap keringat, infeksi jamur atau bakteri atau bahkan eksema. Ruam popok merupakan masalah kulit pada daerah genital bayi yang ditandai dengan timbulnya bercak-bercak merah dikulit, biasanya terjadi pada bayi yang memiliki kulit sensitif dan mudah terkena iritasi. Bercak-bercak ini akan hilang dalam beberapa hari jika dibasuh dengan air hangat, dan diolesi lotion atau cream khusus ruam popok, atau dengan melepaskan popok beberapa waktu.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Incidence rate (angka kejadian) RUAM POPOK berbeda-beda di setiap negara, bergantung pada hygiene, pengetahuan orang tua (pengasuh) <span class="fullpost">tentang tata cara penggunaan popok dan menurut saya mungkin juga berhubungan dengan faktor cuaca. Kimberly A Horii, MD (asisten profesor spesialis anak Universitas Misouri) dan John Mersch, MD, FAAP menyebutkan bahwa 10-20 % Diaper dermatitis dijumpai pada praktek spesialis anak di Amerika. Sedangkan prevalensi pada bayi berkisar antara 7-35%, dengan angka terbanyak pada usia 9-12 bulan. Sementara itu Rania Dib, MD menyebutkan ruam popokk berkisar 4-35 % pada usia 2 tahun pertama.</span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meskipun ruam popok menyebabkan sakit dan sangat mengganggu bayi Ibu, namun biasanya tidak berbahaya. Ruam popok umumnya terjadi pada bayi dengan kulit yang lebih sensitive.Jika ruam pada bayi Ibu disebabkan oleh popok yang basah atau infeksi jamur, maka hanya dengan melepas popok dan membiarkan kulitnya terkena angin sudah mampu menyembuhkan.Pastikan Ibu mengganti popoknya dengan rutin. Membasuh pantat bayi dan mengeringkannya sebelum memakaikan yang baru. Bisa juga menggunakan krim khusus untuk membantu melindungi iritasi pada kulit bayi akibat ruam popok. Untuk mengetahui lebih jelas ha-hal yang berkaitan dengan <i>Diaper rash, </i>maka penulis menyusun makalah yang membahas lebih spesifik mengenai Ruam Popok.</span></span><span class="fullpost"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Penulisan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan dari pembuatan makalah ini adalah untuk membahas lebih spesifik dari Diaper rash, Manifestasi Klinis serta tata cara pelaksanaan dan pencegahannya. Selain itu, dalam makalah ini disertakan pula <i>Asuhan Keperawatan Diaper Rash</i>, yang bertujuan untuk memudahkan kita dalam menanggulangi/ memberi tindakan pada bayi/ anak yang terkena ruam popok<span> </span>sesuai dengan tindakan prosedur keperawatan yang benar.</span></span><span class="fullpost"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manfaat</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manfaat dari asuhan keperawatan anak dengan <i>Diaper Rash</i> adalah untuk membantu dalam melakukuan asuhan keperawatan yang valid mulai dari pengkajian, diagnose keperawatan, proses kaperawatan, implementasi, dan evaluasi.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;"><br />
</div><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b> <div align="center" class="MsoListParagraphCxSpFirst" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMBAHASAN DIAPER RASH</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengertian</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ruam popok adalah iritasi pada kulit bayi Ibu di daerah pantat. Ini bisa terjadi jika ia popok basahnya telat diganti, popoknya terlalu kasar dan tidak menyerap keringat, infeksi jamur atau bakteri atau bahkan eksema</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. <span class="fullpost">Ruam popok merupakan masalah kulit pada daerah genital bayi yang ditandai dengan timbulnya bercak-bercak merah dikulit, biasanya terjadi pada bayi yang memiliki kulit sensitif dan mudah terkena iritasi. Bercak-bercak ini akan hilang dalam beberapa hari jika dibasuh dengan air hangat, dan diolesi lotion atau cream khusus ruam popok, atau dengan melepaskan popok beberapa waktu.</span> <span class="fullpost">Ruam popok (diaper rash) adalah gangguan yang lazim ditemukan pada bayi. Gangguan ini banyak mengenai bayi berumur kurang dari 15 bulan, terutama pada kisaran usia 8 - 10 bula</span></span><span class="fullpost"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><span class="fullpost"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anatomi & Fisiologi Organ Kulit</span></b><span class="fullpost"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Epidermis (Kutilkula) Epidermis merupakan lapisan terluar dari kulit, yang memiliki struktur tipis dengan ketebalan sekitar 0,07 mm terdiri atas beberapa lapisan, antara lain seperti berikut :</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stratum korneum yang disebut juga lapisan zat tanduk.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Letak lapisan ini berada paling luar dan merupakan kulit mati. Jaringan epidermis ini disusun oleh 50 lapisan sel-sel mati, dan akan mengalami pengelupasansecara perlahan-lahan, digantikan dengan sel telur yang baru.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stratum lusidum, yang berfungsi melakukan “pengecatan” terhadap kulit dan rambut. Semakin banyak melanin yang dihasilkan dari sel-sel ini, maka warna kulit akan menjadi semakin gelap.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stratum granulosum, yang menghasilkan pigmen warna kulit, yang disebut melamin. Lapisan ini terdiri atas sel-sel hidup dan terletak pada bagian paling bawah dari jaringan epidermis.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stratum germinativum, sering dikatakan sebagai sel hidup karena lapisan ini merupakan lapisan yang aktif membelah. Sel-selnya membelah ke arah luar untuk membentuk sel-sel kulit teluar. Sel-sel yang baru terbentuk akan mendorong sel-sel yang ada di atasnya selanjutnya sel ini juga akan didorong dari bawah oleh sel yang lebih baru lagi. Pada</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">saat yang sama sel-sel lapisan paling luar mengelupas dan gugur.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jaringan dermis memiliki struktur yang lebih rumit daripada epidermis, yang terdiri atas banyak lapisan. Jaringan ini lebih tebal daripada epidermis yaitu sekitar 2,5 mm. Dermis dibentuk oleh serabut-serabut khusus yang membuatnya lentur, yang terdiri atas kolagen, yaitu suatu jenis protein yang membentuk sekitar 30% dari protein tubuh. Kolagen akan berangsur-angsur berkurang seiring dengan bertambahnya usia. Itulah sebabnya seorang yang sudah tua tekstur kulitnya kasar dan keriput. Lapisan dermis terletak di bawah</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lapisan epidermis. Lapisan dermis terdiri atas bagian-bagian berikut. Folikel rambut dan struktur sekitarnya</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Akar Rambut</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di sekitar akar rambut terdapat otot polos penegak rambut (Musculus arektor pili), dan ujung saraf indera perasa nyeri. Udara dingin akan membuat otot-otot ini berkontraksi dan mengakibatkan rambut akan berdiri. Adanya saraf-saraf perasa mengakibatkan rasa nyeri apabila rambut dicabut.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembuluh Darah</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembuluh darah banyak terdapat di sekitar akar rambut. Melalui pembuluh darah ini akar-akar rambut mendapatkan makanan, sehingga rambut dapat tumbuh.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar Minyak (glandula sebasea) </span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar minyak terdapat di sekitar akar rambut. Adanya kelenjar minyak ini dapat menjaga agar rambut tidak kering.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar Keringat (glandula sudorifera)</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar keringat dapat menghasilkan keringat. Kelenjar keringat berbentuk botol dan bermuara di dalam folikel rambut. Bagian tubuh yang banyak terdapat kelenjar keringat adalah bagian kepala, muka, sekitar hidung, dan lain-lain. Kelenjar keringat tidak terdapat dalam kulit tapak tangan dan telapak kaki.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Serabut Saraf</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada lapisan dermis terdapat puting peraba yang merupakan ujung akhir saraf sensoris. </span></span><span class="fullpost"><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ujung-ujung saraf tersebut merupakan indera perasa panas, dingin, nyeri, dan sebagainya.Jaringan dermis juga dapat menghasilkan zat feromon, yaitu suatu zat yang memiliki bau khas pada seorang wanita maupun laki-laki. Feromon ini dapat memikat Lawan<span> </span>jenisDermis (Kulit Jangat)</span></span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi</span></b><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beberapa faktor penyebab terjadinya ruam popok ( diaper rash, diaper dermatitis, napkin dermatitis ), antara lain:</span></span><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Iritasi atau gesekan antara popok dengan kulit.</span></span><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurangnya menjaga hygiene. popok jarang diganti atau terlalu lama tidak segera diganti setelah pipis atau BAB (feces).</span></span><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi mikro-organisme (terutama infeksi jamur dan bakteri)</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Alergi bahan popok.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan pada kelenjar keringat di area yang tertutup popok.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kebersihan kulit yang tidak terjaga.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jarang ganti popok setelah bayi/anak kencing.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Udara/suhu lingkungan yang terlalu panas/lembab</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Akibat mencret</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>10.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Reaksi kontak terhadap karet, plastik, detergen</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patofisiologi</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hampir semua bayi pernah mengalami ruam atau lecet karena pemakaian popok.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" /> <span class="fullpost">Lokasi yang sering terkena adalah bagian pantat, sekitar kemaluan, maupun paha.</span><br clear="all" /> <span class="fullpost">Bahkan, jika bakteri yang terdapat dalam urine bayi Anda terurai menjadi amonia, ruam ini bisa bertambah parah. Tentu saja keadaan ini sangat tidak menyenangkan buat si kecil.</span></span><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 0cm;"><span class="fullpost"><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun proses dari Diaper Rash adalah sbb</span></i></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-indent: 0cm;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-indent: 0cm;"> <span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemakaian Popok<span> - </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada daerah pantat,kemaluan,Paha<span> - </span>Hipotalamus memberi rangsangan pada anak untuk BAK - Anak kecil tidak bias menahan spinter<span> - </span>BAK<span> -</span><span> </span>Popok basah - Urin menguraikan amoniak<span> - </span>Menimbulkan bakteri<span> - </span>Gangguan rasa nyaman<span> </span><span>- </span>Imobilitas kulit<span> - </span><span></span>Kerusakan kulit<span> - </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan integritas kulit<span></span><span> - </span>Ruam popok.<span style="color: #333333;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: -7.1pt; text-indent: 0cm;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi Klinis</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ruam kemerahan atau lecet pada kulit di daerah yang ditutupi popok. </span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi biasanya terlihat rewel, terutama saat penggantian popok. </span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bayi juga mungkin menangis saat kulit di daerah yang ditutupi popok dicuci atau disentuh.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat bercak-bercak kemerahan pada daerah pantat karena iritasi popok.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Iritasi pada kulit yang terkena, muncul sebagai eritema</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Erupsi pada daerah kontak yang menonjol seperti : pantat, alat kemaluan, perut bawah, paha atas.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keadaan parah : papila eritematosa, Vesikula dan Ulserasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terapi / Penatalaksanaan</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sering-seringlah mengganti popok. Jangan biarkan popok yang sudah basah karena menampung banyak urin berlama-lama dipakai bayi. Kontak yang lama antara urin atau tinja dengan kulit bayi dapat menimbulkan ruam popok.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saat membersihkan bayi, tepuk daerah yang biasa ditutupi popok (bokong, paha, selangkangan, dan daerah genital bayi) secara perlahan dengan handuk bersih. Usahakan menghindari menggosok-gosok dengan keras daerah tersebut.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sesekali biarkan bokong bayi terbuka (tidak memasang popok) selama beberapa saat. Tindakan ini mungkin berguna menjaga daerah popok tetap kering dan bersih.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hati-hati dalam memilih popok, karena beberapa jenis bahan popok dapat merangsang ruam popok. Jika hal itu terjadi, gantilah popok merk lain yang lebih cocok.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jika bayi anda memakai popok kain yang digunakan berulang kali, cucilah popok kain tersebut dengan deterjen yang formulanya tidak terlalu keras. Hindari memakai pelembut, karena pewangi dalam pelembut tersebut dapat mengiritasi kulit bayi. Pastikan untuk membilas popok dengan baik agar deterjen tidak tertinggal di dalam popok.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hindari memasang popok terlalu kuat. Usahakan ada ruang antara popok dengan kulit bayi.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="margin-left: 0cm;"><br />
</div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ASUHAN KEPERAWATAN</span></b></div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DIAPER RASH</span></b></div><div class="MsoNormal" style="margin-left: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas klien</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Idetitas Keluarga</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola sensori</span></span><span class="fullpost"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan fisik (status kesehatan umum, pemeriksaan head to toe, pemeriksaan penunjang)</span></span><span class="fullpost"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan tanda-tanda fital dan riwayat penggunaan obat-obatan.</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpLast" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan</span></b></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span lang="IN"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333;">Imobilitas berhubungan dengan decubitus</span></span></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span lang="IN"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333;">Resiko infeksi berhubungan dengan incontinensia</span></span></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span lang="IN"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333;">Aktual infeksi, sepsis berhubungan dengan adanya infeksi (dekubitus)</span></span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi Keperawatan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan rasa nyaman nyeri berhubungan dengan kerusakan kulit / jaringan</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" /> <span class="fullpost"><i>Tujuan:</i></span> <span class="fullpost">Setelah dilakukan tindakan keperawatan selama 2x24 jam diharapkan nyeri dapat teratasi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><span class="fullpost"><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil:</span></i></span><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri berkurang / terkontrol</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ekspresi wajah rileks.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><span class="fullpost"><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Itervensi:</span></i></span><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></i></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pastikan ibu mengganti popoknya secara rutin.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><span class="fullpost"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> supaya permukaan tidak dalam keadaan lembab/ basah.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan tempat tidur ayunan secara indikasi</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">peninggian linen dari luka membantu menurunkan nyeri</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membasuh pantat bayi dan mengeringkanya</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">Untuk mencegah terjadinya iritasi pada kulit bayi</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Melepas popok dan membiarkan kulitnya terkena angin</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><span class="fullpost"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mempercepat penyembuhan ruam popok</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan integritas kulit berhubungan dengan kerusakan permukaan kulit karena destruksi jaringan.</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><span class="fullpost"><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan:</span></i></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">Setelah dilakukan tindakan keperawatan selama 2x24 jam diharapkan masalah dapat teratasi.</span></span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><span class="fullpost"><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria Hasil:</span></i></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan regenerasi jaringan</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencapai penyembuhan tepat waktu.</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><span class="fullpost"><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:</span></i></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan perawatan ruam popok dengan tepat dan tindakan control infeksi.</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> menyiapkan jaringan baru dan menurunkan infeksi.</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinggikan area graft bila mungkin</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">menurunkan pembengkakan / mengatasiresiko pemisahan graft</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau kondisi luka yang terjadi akibat ruam popok.</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">memberikan informasi dasar tentang keb penanaman kulit</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cuci sisi dengan sabun ringan, cuci dan minyai dengan krim.</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: 0cm;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">kulit graft baru dan sisi donor yang sembuh memerlukan perawatan khusus</span></span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan mobilitas fisik, kerusakan</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 0cm;"><span class="fullpost"><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan:</span></i></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Setelah dilakukan tindakan kep selama 2x24 jam diharapkan masalah dapat teratasi.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br clear="all" /> <span class="fullpost"><i>Kriteria Hasil:</i></span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan keinginan berpartisipasi dalam aktifitas.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan posisi fungsi dibuktikan oleh tidak adanya kontraktus.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan teknik / perilaku yang memampukan melakukan aktivitas.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 0cm;"><span class="fullpost"><i><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:</span></i></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertahankan posisi tubuh tepat</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><span class="fullpost"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span> </span>meningkatkan fungsional pada ekstremitas.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan rehabilitasi.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><span class="fullpost"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> akan lebih mudah membuat partisipasi</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan obat sebelum aktivitas/ latihan</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> M<span class="fullpost">enurunkan kekuatan otot/ jaringan.</span></span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bersihkan daerah luka dengan cepat.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 0cm;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span class="fullpost">eksisi dinidiket untuk menurunkan jaringan parut serta resiko infeksi.</span></span><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">EVALUASI<span style="color: #333333;"></span></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa 1</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri berkurang / terkontrol</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ekspresi wajah rileks.</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa 2</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan regenerasi jaringan</span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencapai penyembuhan tepat waktu</span></span><span class="fullpost"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa 3</span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan keinginan berpartisipasi dalam aktifitas.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan posisi fungsi dibuktikan oleh tidak adanya kontraktus.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menunjukan teknik / perilaku yang memampukan melakukan aktivitas.</span></span><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b><br />
<div align="center" class="MsoListParagraphCxSpFirst" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB IV</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENUTUP</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesimpulan & Saran</span></b></div><div class="MsoListParagraphCxSpLast" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meskipun ruam popok menyebabkan sakit dan sangat mengganggu bayi Ibu, namun biasanya tidak berbahaya. Ruam popok umumnya terjadi pada bayi dengan kulit yang lebih sensitive. Jika ruam pada bayi Ibu disebabkan oleh popok yang basah atau infeksi jamur, maka hanya dengan melepas popok dan membiarkan kulitnya terkena angin sudah mampu menyembuhkan.Pastikan Ibu mengganti popoknya dengan rutin. Membasuh pantat bayi dan mengeringkannya sebelum memakaikan yang baru. Bisa juga menggunakan krim khusus untuk membantu melindungi iritasi pada kulit bayi akibat ruam popok</span></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 21.3pt; text-indent: 21.25pt;"><br />
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</style> <![endif]--> <div align="center" class="MsoNormal" style="line-height: 200%; margin-bottom: 0.0001pt; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">DAFTAR PUSTAKA</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Arvin, dkk. 1999. <i>Ilmu Kesehatan Anak Nelson. Vol 1. Edisi 15</i>. Jakarta: EGC.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Danis, Difa. <i>Kamus Istilah Kedokteran</i>.Gitamedia Press.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Doenges, E Marilynn, dkk. 1999. <i>Rencana Asuhan Keperawatan.</i> Jakarta : EGC.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Posted by Defka Blog. <i>Askep Ruam Popok.</i> (Tanggal Posting 10 Januari 2011/ Online; Diakses tanggal 19 Januari 2011).</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN"><a href="http://www.google.com/"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; text-decoration: none;">www.google.com</span></a></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> / <i>Diaper Rash.</i> (Online, diakses tanggal 19 Januari 2011 ).</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN"><a href="http://www.tanya/"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%; text-decoration: none;">www.tanya</span></a></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dokter anda.com / <i>Diaper rash.</i> (Online; siakses tanggal 19 januari 2011).</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0tag:blogger.com,1999:blog-2695819362399801347.post-60416008159172382402011-02-18T16:49:00.000-08:002011-02-18T16:49:43.912-08:00Askep Ileus Obstruktif<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi intestinal merupakan kegawatan dalam bedah abdominalis yang sering dijumpai, merupakan 60--70% dari seluruh kasus akut abdomen yang bukan appendicitis akuta. Penyebab yang paling sering dari obstruksi ileus adalah adhesi/ streng, sedangkan diketahui bahwa operasi abdominalis dan operasi obstetri-ginekologik makin sering dilaksanakan yang terutama didukung oleh kemajuan di bidang diagnostik kelainan abdominalis.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ileus obstruktif adalah suatu penyumbatan mekanis pada usus dimana merupakan penyumbatan yang sama sekali menutup atau menganggu jalannya isi usus (Sabara, 2007). Setiap tahunnya 1 dari 1000 penduduk dari segala usia didiagnosa ileus (Davidson, 2006). Di Amerika diperkirakan sekitar 300.000-400.000 menderita ileus setiap tahunnya (Jeekel, 2003). Di Indonesia tercatat ada 7.059 kasus ileus paralitik dan obstruktif tanpa hernia yang dirawat inap dan 7.024 pasien rawat jalan pada tahun 2004 menurut Bank data Departemen Kesehatan Indonesia.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada 3 hal yang tetap menarik untuk diketahui/diselidiki tentang obstruksi ileus, ialah :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Makin meningkatnya keterdapatan obstruksi ileus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa obstruksi ileus sebenarnya mudah dan bersifat universil; tetapi untuk mengetahui proses patologik yang sebenarnya di dalam rongga abdomen tetap merupakan hal yang sulit.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bahaya strangulasi yang amat ditakuti sering tidak disertai gambaran klinik khas yang dapat mendukungnya. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk dapat melaksanakan penanggulangan penderita obstruksi ileus dengan cara yang sebaik - baiknya, diperlukan konsultasi antara disiplin yang bekerja dalam satu tim dengan tujuan untuk mencapai 4 keuntungan :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila penderita harus dioperasi, maka operasi dijalankan pada saat keadaan umum penderita optimal.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat mencegah strangulasi yang terlambat.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencegah laparotomi negatif.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penderita mendapat tindakan operatif yang sesuai dengan penyebab obstruksinya</span></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;">Terapi ileus obstruksi biasnya melibatkan intervensi bedah. Penentuan waktu kritis serta tergantung atas jenis dan lama proses ileus obstruktif. Operasi dilakukan secepat yang layak dilakukan dengan memperhatikan keadaan keseluruhan pasien (Sabiston, 1995).</div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><a href="" name="_Toc281844320"></a><a href="" name="_Toc274652793"></a><a href="" name="_Toc266819774"></a><a href="" name="_Toc263606280"></a><a href="" name="_Toc263595589"></a><a href="" name="_Toc263718130"></a><a href="" name="_Toc263717506"><span><span><span><span><span><span><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perumusan Masalah</span></b></span></span></span></span></span></span></a><span></span><span></span><span></span><span></span><span></span><span></span><span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="letter-spacing: -0.2pt;">Berdasarkan </span><span lang="IT">uraian</span><span lang="IN" style="letter-spacing: -0.2pt;"> latar belakang di atas, </span><span style="letter-spacing: -0.2pt;">maka fokus </span><span lang="IN" style="letter-spacing: -0.2pt;">permasalahan dalam</span><span style="letter-spacing: -0.2pt;"> makalah</span><span lang="IN" style="letter-spacing: -0.2pt;"> ini adalah:</span><span style="letter-spacing: -0.2pt;"></span></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="letter-spacing: -0.2pt;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="letter-spacing: -0.2pt;">Apa yang dimaksud dengan ileus obstruksi?</span></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-indent: -21.25pt;"><span style="letter-spacing: -0.2pt;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="letter-spacing: -0.2pt;">Bagaimana proses keperawatan pada klien dengan ileus obstruksi?</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan </span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">Berdasarkan rumusan permasalahan, maka makalah ini bertujuan untuk:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">Mengetahui </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">apa yang dimaksud dengan ileus obstruksi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; letter-spacing: -0.2pt; line-height: 150%;">Memiliki intelektual dan keterampilan dalam memberikan asuhan keperawatan pada klien dengan ileus obstruksi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> </span></b> <div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMBAHASAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anatomi Fisiologi Sistem Pencernaan<span> </span><span> </span></span></b></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anatomi fisiologi tentang sistem pencernaan yang meliputi:<span> </span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mulut<span> </span><br />
Mulut adalah permulaan saluran pencernaan yang terdiri atas 2 bagian yaitu:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian luar yang sempit atau vestibula yaitu diruang antara gusi, bibir dan pipi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rongga mulut/bagian dalam yaitu rongga mulut yang dibatasi sisinya oleh tulang maksilaris, palatum dan mandi bilaris disebelah belakang bersambung dengan faring.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faring<br />
Faring merupakan organ yang menghubungkan rongga mulut dengan kerongkongan, merupakan persimpangan jalan nafas dan jalan makanan, letaknya dibelakang rongga mulut dan didepan ruas tulang belakang.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Esofagus (kerongkongan)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Panjangnya ± 25 cm, mulai dari faring sampai pintu masuk kardiak dibawah lambung. Esofagus terletak dibelakang trakea dan didepan tulang punggung setelah melalui thorak menembus diafragma masuk kedalam abdomen ke lambung.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gaster (lambung)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merupakan bagian dari saluran pencernaan yang dapat mengembang paling banyak terutama didaerah epigaster. Bagian-bagian lambung antara lain:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fundus ventrikularis, bagian yang menonjol keatas terletak disebelah kiri osteum kardium biasanya berisi gas.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Korpus ventrikuli, setinggi osteum kardium, suatu lekukan pada bagian bawah notura minor.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Antrum pilorus, berbentuk tebing mempunyai otot tebal membentuk spinkter pilorus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurtura minor, terletak disebelah kanan lambung, terdiri dari osteum kordi samapi pilorus.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurtura mayor, lebih panjang dari kurtura minor terbentang dari sisi kiri osteum kardium melalui fundus kontrikuli menuju kekanan sampai ke pilorus anterior.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi lambung</span></i></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menampung makanan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Getah cerna lambung yang dihasilkan pepsin, asam garam, renin dan lipak.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usus halus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usus halus merupakan bagian dari sistem pencernaan makanan yang berpangkal pada pilorus dan berakhir pada sekum panjangnya ± 6cm, merupakan saluran paling panjang tempat proses pencernaan dan obstruksi hasil pencernaan makanan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Duodenum<br />
Disebut juga usus 12 jari, panjangnya ± 25 cm, berbentuk sepatu kuda melengkung kekiri, pada lengkungan ini terdapat pankreas. Pada bagian kanan duodenum terdapat selaput lendir yang nambulir disebut papila vateri.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yeyunum dan ileum</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Panjangnya sekitar ± 6 meter. Dua perlima bagian atas adalah yeyunum dengan ± 2-3 meter dan ileum dengan panjang ± 4-5 meter. Lekukan yeyunum dan ileum melekat pada dinding abdomen fasterior dengan perantara lipatan peritoneum yang berbentuk kipas disebut mesentrium.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mukosa usus halus</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Permukaan epitel yang sangat halus melalui lipatan mukosa dan makro villi memudahkan penernaan dan absorpasi</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi usus halus:</span></i></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menerima zat-zat makanan yang sudah dicerna untuk diserap melalui kapiler-kapiler darah dan saluran-saluran limfe.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Menyerap protein dalam bentuk asam amino.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Karbohirat diserap dalam bentuk monosakarida didalam usus halus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Usus besar/interdinum mayor</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Panjangnya ± 1 meter, lebar 5-6 cm, fungsinya menyerap air dari makanan, tempat tinggal bakteri koli, tempat feces. Usus besar terdiri atas 7 bagian:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sekum.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolon asenden.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terletak di abdomen sebelah kanan, membujur ke atas dari ileum sampai ke hati, panjangnya ± 13 cm.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Appendiks (usus buntu)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sering disebut umbai cacing dengan panjang ± 6 cm.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolon transversum.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membujur dari kolon asenden sampai ke kolon desenden dengan panjang ± 28 cm.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolon desenden.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terletak dirongga abdomen disebelah kiri membujur dari anus ke bawah dengan panjangnya ± 25 cm.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolon sigmoid.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terletak dalam rongga pelvis sebelah kiri yang membentuk huruf "S" ujung bawah berhubungan dengan rektum.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rektum.<br />
Terletak dibawah kolon sigmoid yang menghubungkan intestinum mayor dengan anus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anus.<br />
Anus adalah bagian dari saluran pencernaan yang menghubungkan rektum dengan dunia luar. (Drs. Syaifuddin, hal 87-92).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Definisi<span> </span>Ileus<span> </span>Obstruktif</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi usus dapat didefinisikan sebagai gangguan (apapun penyebabnya) aliran normal isi usus sepanjang saluran usus. Obstruksi usus dapat akut dengan kronik, partial atau total. Obstruksi usus biasanya mengenai kolon sebagai akibat karsino ma dan perkembangannya lambat. Sebahagaian dasar dari obstruksi justru mengenai usus halus.Obstruksi total usus halus merupakan keadaan gawat yang memerlukan diagnosis dini dan tindakan pembedahan darurat bila penderita ingin tetap hidup.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -7.1pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada dua tipe obstruksi yaitu :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mekanis (Ileus Obstruktif)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suatu penyebab fisik menyumbat usus dan tidak dapat diatasi oleh peristaltik. Ileus obstruktif ini dapat akut seperti pada hernia stragulata atau kronis akibat karsinoma yang melingkari. Misalnya intusepsi, tumor polipoid dan neoplasma stenosis, obstruksi batu empedu, striktura, perlengketan, hernia dan abses.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Neurogenik/fungsional (Ileus Paralitik)</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi yang terjadi karena suplai saraf ototnom mengalami paralisis dan peristaltik usus terhenti sehingga tidak mampu mendorong isi sepanjang usus. Contohnya amiloidosis, distropi otot, gangguan endokrin seperti diabetes mellitus, atau gangguan neurologis seperti penyakit parkinson</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beberapa pengertian obstruksi usus dan ileus obstruksi menurut para ahli, yaitu:</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi usus</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah sumbatan total atau parsial yang mencegah aliran normal melalui saluran pencernaan. (Brunner and Suddarth, 2001).<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi usus</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah gangguan isi usus disepanjang saluran usus (Patofisiologi vol 4, hal 403).<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi usus</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah gangguan pada aliran normal isi usus sepanjang traktus intestinal (Nettina, 2001). </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> terjadi ketika ada gangguan yang menyebabkan terhambatnya aliran isi usus ke depan tetapi peristaltiknya normal (Reeves, 2001). </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi usus</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> merupakan suatu blok saluran usus yang menghambat pasase cairan, flatus dan makanan dapat secara mekanis atau fungsional (Tucker, 1998).</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ileus obstruktif</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah suatu penyumbatan mekanis pada usus dimana merupakan penyumbatan yang sama sekali menutup atau menganggu jalannya isi usus (Sabara, 2007).</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dari definisi diatas dapat disimpulkan bahwa <i>obstruksi usus</i> adalah sumbatan total atau parsial yang menghalangi aliran normal melalui saluran pencernaan atau gangguan usus disepanjang usus. Sedangkan <i>Ileus obstruktif</i> adalah kerusakan atau hilangnya pasase isi usus yang disebabkan oleh sumbatan mekanik.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><b>Etiologi</b><span> </span><br />
Adapun penyebab dari obstruksi usus dibagi menjadi dua bagian menurut jenis obstruksi usus, yaitu:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mekanis : Terjadi obstruksi intramunal atau obstruksi munal dari tekanan pada usus, contohnya adalah intrasusepsi, tumor dan neoplasma, stenosis, striktur, perlekatan, hernia dan abses.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsional : Muskulator usus tidak mampu mendorong isi sepanjang usus (Brunner and Suddarth).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></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="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peristiwa patofisiologi yang terjadi setelah obstruksi usus adalah sama, tanpa memandang apakah obstruksi usus tersebut diakibatkan oleh penyebab mekanik atau fungsional. Perbedaan utamanya adalah obstruksi paralitik, paralitik dihambat dari permulaan, sedangkan pada obstruksi mekanis peristaltik mula-mula diperkuat kemudian intermiten akhirnya hilang. Limen usus yang tersumbat profesif akan terenggang oleh cairan dan gas. Akumulasi gas dan cairan didalam lumen usus sebelah proksimal dari letak obstruksi mengakibatkan distensi dan kehilangan H2O dan elektrolit dengan peningkatan distensi maka tekanan intralumen meningkat, menyebabkan penurunan tekanan vena dan kapiler arteri sehingga terjadi iskemia dinding usus dan kehilangan cairan menuju ruang peritonium akibatnya terjadi pelepasan bakteri dan toksin dari usus, bakteri yang berlangsung cepat menimbulkan peritonitis septik ketika terjadi kehilangan cairan yang akut maka kemungkinan terjadi syok hipovolemik. Keterlambatan dalam melakukan pembedahan atau jika terjadi stranggulasi akan menyebabkan kematian. (Pice and Wilson, hal 404)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi Klinik</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri tekan pada abdomen.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Konstipasi (sulit BAB).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Distensi abdomen.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB darah dan lendir tapi tidak ada feces dan flatus (Kapita Selekta, 2000, hal 318).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></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><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun pemeriksaan diagnostik yang bisa dilakukan antara lain:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan sinar x: Untuk menunjukan kuantitas abnormal dari gas atau cairan dalam usus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan laboratorium (misalnya pemeriksaan elektrolit dan jumlah darah lengkap) akan menunjukan gambaran dehidrasi dan kehilangan volume plasma dan kemungkinan infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan radiogram abdomen sangat penting untuk menegakkan diagnosa obstruksi usus. Obstruksi mekanis usus halus ditandai oleh udara dalam usus halus, tetapi tidak ada gas dalam usus. Bila foto fokus tidak memberi kesimpulan, dilakukan radiogram barium untuk mengetahui tempat obstruksi (Brunner and Suddarth, 2001, hal 1121).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan Bedah dan Medis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dasar pengobatan obstruksi usus adalah koreksi keseimbangan cairan dan elektrolit, menghilangkan peregangan dan muntah dengan intubasi dan kompresi, memperbaiki peritonitis dan syok bila ada, serta menghilangkan obstruksi untuk memperbaiki kelangsungan dan fungsi usus kembali normal.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi Usus Halus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dekompresi pada usus melalui selang usus halus atau nasogastrik bermamfaat dalam mayoritas kasus obstruksi usus halus.Apabila usus tersumbat secara lengkap, maka strangulasi yang terjadi memerlukan tindakan pembedahan, sebelum pembedahan, terapi intra vena diperlukan untuk mengganti kehilangan cairan dan elektrolit (natrium, klorida dan kalium).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tindakan pembedahan terhadap obstruksi usus halus tergantung penyebab obstruksi. Penyebab paling umum dari obstruksi seperti hernia dan perlengketan. Tindakan pembedahannya adalah herniotomi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi Usus Besar</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apabila obstruksi relatif tinggi dalam kolon, kolonoskopi dapat dilakukan untuk membuka lilitan dan dekompresi usus. Sekostomi, pembukaan secara bedah yang dibuat pasa sekum, dapat dilakukan pada pasien yang berisiko buruk terhadap pembedahan dan sangat memerlukan pengangkatan obstruksi. Tindakan lain yang biasa dilakukan adalah reseksi bedah utntuk mengangkat lesi penyebab obstruksi. Kolostomi sementara dan permanen mungkin diperlukan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritonitis karena absorbsi toksin dalam rongga peritonium sehinnga terjadi peradangan atau infeksi yang hebat pada intra abdomen.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perforasi dikarenakan obstruksi yang sudah terjadi selalu lama pada organ intra abdomen.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sepsis, infeksi akibat dari peritonitis, yang tidak tertangani dengan baik dan cepat.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Syok hipovolemik terjadi akibat dehidrasi dan kehilangan volume plasma.<br />
(Brunner and Suddarth, 2001, hal 1122).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III<br />
KONSEP<span> </span>KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian adalah tahap awal dari proses keperawatan dan merupakan upaya untuk pengumpulan data secara lengkap dan sistematis mulai dari pengumpulan data, identitas dan evaluasi status kesehatan klien. (Nursalam, 2001).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biodata klien yang penting meliputi nama, umur, jenis kelamin, agama, suku dan gaya hidup.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluhan utama .<span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keluhan utama adalah keluhan yang dirasakan klien pada saat dikaji. Pada umumnya akan ditemukan klien merasakan nyeri pada abdomennya biasanya terus menerus, demam, nyeri tekan lepas, abdomen tegang dan kaku.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan sekarang </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengungkapkan hal-hal yang menyebabkan klien mencari pertolongan, dikaji dengan menggunakan pendekatan PQRST :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">P : Apa yang menyebabkan timbulnya keluhan.</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: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Q :Bagaiman keluhan dirasakan oleh klien, apakah hilang, timbul atau terus- <span> </span>menerus (menetap).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R : Di daerah mana gejala dirasakan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">S : Seberapa keparahan yang dirasakan klien dengan memakai skala numeric 1 s/d 10.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">T :Kapan keluhan timbul, sekaligus factor yang memperberat dan memperingan keluhan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan masa lalu</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perlu dikaji apakah klien pernah menderita penyakit yang sama, riwayat ketergantungan terhadap makanan/minuman, zat dan obat-obatan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan keluarga </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apakah ada anggota keluarga yang mempunyai penyakit yang sama dengan klien.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksan fisik</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aktivitas/istirahat</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala : Kelelahan dan ngantuk.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda : Kesulitan ambulasi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirkulasi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala : Takikardia, pucat, hipotensi ( tanda syok)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Eliminasi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala : Distensi abdomen, ketidakmampuan defekasi dan Flatus</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda<span> </span>: </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan warna urine dan feces</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Makanan/cairan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="ES-AR" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala : anoreksia,mual/muntah dan haus terus menerus.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda : muntah berwarna hitam dan fekal. Membran mukosa pecah-pecah. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kulit buruk.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri/Kenyamanan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala : Nyeri abdomen terasa seperti gelombang dan bersifat kolik. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda : Distensi abdomen dan nyeri tekan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pernapasan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala : Peningkatan frekuensi pernafasan, </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda : Napas pendek dan dangkal</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnostik Test</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan sinar X: akan menunjukkan kuantitas abnormal dari gas dan cairan dalam usus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan simtologi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hb dan PCV: meningkat akibat dehidrasi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Leukosit: normal atau sedikit meningkat</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Ureum dan eletrolit: ureum meningkat, Na<sup>+</sup> dan Cl<sup>‑ </sup>rendah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rontgen toraks: diafragma meninggi akibat distensi abdomen</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rontgen abdomen dalam posisi telentang: mencari penyebab (batu empedu, volvulus, hernia)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 3cm; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sigmoidoskopi: menunjukkan tempat obstruktif. <span> </span>(Doenges, Marilynn E, 2000)</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan</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: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa keperawatan adalah suatu pernyataan yang menjelaskan respon manusia (status kesehatan, resiko perubahan pola hidup) dari individu atau kelompok dimana perawat secara akuntabilitas dapat mengidentifikasi dan memberi intervensi pasti untuk menjaga status kesehatan, menurunkan, membatasi, mencegah dan merubah (Carpenito, 2000).<span> </span></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa keperawatan merupakan respon klien terhadap adanya masalah kesehatan. Oleh karena itu diagnosa keperawatan berorientasi pada kebutuhan dasar manusia berdasarkan teori kebutuhan dasar Abraham Maslow (Gaffar, 1996).</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun diagnosa keperawatan yang sering muncul pada klien dengan ileus obstruksi <span> </span>adalah sebagai berikut : (Doenges, M.E. 2001 dan Wong D.L)</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri b/d distensi abdomen dan adanya selang Nasogastrik tube/ usus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kekurangan volume cairan b/d output berlebihan, mual dan muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan nutrisi kurang dari kebutuhan tubuh b/d </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">gangguan absorbsi nutrisi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurang pengetahuan tentang kondisi/situasi, prognosis dan kebutuhan pengobatan b/d kurangnya pemanjanan/mengingat, kesalahan interpretasi informasi, tidak mengenal sumber informasi, keterbatasan kognitif.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rencana </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: 21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perencanaan meliputi pengembangan strategi desain untuk mencegah, mengurangi atau mengoreksi. Beberapa komponen yang perlu diperhatikan untuk mengevaluasi tindakan keperawatan meliputi menentukan prioritas, menentukan kriteria hasil, menentukan rencana tindakan dan dokumentasi (Nursalam, 2001, hal 52) Adapun renana tindakan dari diagnosa keperawatan yang muncul pada pasien dengan obstruksi usus antara lain:<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri b/d distensi abdomen dan adanya selang Nasogastrik tube/ usus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Nyeri hilang/terkontrol, menunjukkan rileks. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri berkurang sampai hilang.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ekspresi wajah rileks.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TTV dalam batas normal.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Skala nyeri 3-0.<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Selidiki keluhan nyeri, perhatikan lokasi, intensitas (skala 0-10) dan faktor pemberat/penghilang.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Nyeri distensi abdomen, dan mual. Membiarkan pasien rentang ketidaknyamanannya sendiri membantu mengidentifikasi intervensi yang tepat dan mengevaluasi keefektifan analgesia.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau tanda-tanda vital.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Respon autonomik meliputi perubahan pada TD, nadi dan pernafasan, yang berhubungan dengan keluhan/penghilangan energi. Abnormalitas tanda vitalterus menerus memerlukan evaluasi lanjut.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberikan tindakan kenyamanan. Mis: gosokan punggung, pembebatan insisi selama perubahan posisi dan latihan batuk/bernafas; lingkungan tenang. Anjurkan penggunaan bimbingan imajinasi, tehnik relaksasi. Berikan aktivitas hiburan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Memberikan dukungan (fisik, emosional), menurunkan tegangan otot, meningkatkan relaksasi, mengfokuskan ulang perhatian, meningkatkan rasa kontrol dan kemampuan koping.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Palpasi kandung kemih terhadap distensi bila berkemih ditunda. Tingkatkan privasi dan gunakan tindakan keperawatan untuk meningkatkan relaksasi bila bila pasien berupaya untuk berkemih. Tempatkan pada posisi semi-fowler atau berdiri sesuai kebutuhan.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Faktor psikologis dan nyeri dapat meningkatkan tegangan otot. Posisi tegak meningkatkan tekanan intra-abdomen, yang dapat membantu dalam berkemih.</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan analgesik, narkotik, sesuai indikasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mengontrol/mengurangi nyeri untuk meningkatkan istirahat dan meningkatkan kerjasama dengan aturan terapeutik.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kateterisasi sesuai kebutuhan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Kateterisasi tunggal/multifel dapat digunakan untuk mengosongkan kandung kemih sampai fungsinya kembali. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kekurangan volume cairan b/d output berlebihan, mual dan muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Volume cairan seimbang.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien mendapat cairan yang cukup untuk mengganti cairan yang hilang.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien menunjukkan tanda-tanda hidrasi yang adekuat.<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau tanda-tanda vital dengan sering, perhatikan peningkatan nadi, perubahan TD, takipnea, dan ketakutan. Periksa balutan dan luka dengan sering selama 24 jam pertama terhadap tanda-tanda darah merah terang atau bengkak insisi berlebihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Tanda-tanda awal hemoragi usus atau pembentukan hematoma, yang dapat menyebabkan syok hipovolemik.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Palpasi nadi perifer, evaluasi pengisian kapiler, turgor kulit dan status membran mukosa.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Memberi informasi tentang volume sirkulasi umum dan tingkat hidrasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perhatikan adanya edema.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Edema dapat terjadi kerena perpindahan cairan berkenaan dengan penurunan kadar albumin serum/protein.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau masukan dan haluaran, perhatikan haluaran urine, berat jenis,. Kalkulasi keeimbangan 24 jam, dan timbang berat badan setiap hari.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Indikator langsung dari hidrasi/perfusi organ dan fungsi. Memberikan pedoman untuk penggantian cairan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perhatikan adanya/ukur distensi abdomen.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perpindahan cairan dari ruang vaskuler menurunkan volume sirkulasi dan merusak perfusi ginjal.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi/catat kuantitas, jumlah dan karakter drainase NGT. tes pH sesuai indikasi. Anjurkan dan bantu dengan perubahan posisi sering.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Haluaran cairan berlebihan dapat menyebabkan ketidakseimbangan eletrolit dan alkalosis metabolik dengan kehilangan lanjut kalium oleh ginjal yang berupaya untuk mengkompensasi. Hiperasiditas, ditunjukkan oleh pH kurang dari 5, menunjukkan pasien beresiko ulkus stres. Pengubahan posisi mencegah pembentukan magenstrase di lambung, yang dapat menyalurkan cairan gastrik dan udara melalui selang NGT kedalam duodenum. </span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi: </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertahankan potensi penghisap NGT/usus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Meningkatkan dekompresi usus untuk menurunkan distensi/tekanan di garis jahitan dan menurunkan mual/muntah, yang dapat menyertai anastesia,manipulasi usus atau kondisi yang sebelumnya ada, mis: kanker.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan nutrisi kurang dari kebutuhan tubuh b/d gangguan absorbsi nutrisi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Berat badan stabil dan nutrisi teratasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ada tanda-tanda mal nutrisi.<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berat badan stabil.<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien tidak mengalami mual muntah.<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinjau faktor-faktor individual yang mempengaruhi kemampuan untuk mencerna makanan, mis: status puasa, mual, ileus paralitik setelah selang dilepas.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mempengaruhi pilihan intervensi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Auskultasi bising usus; palpasi abdomen; catat pasase flatus.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menentukan kembalinya peristaltik (biasanya dalam 2-4 hari).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi kesukaan/ketidaksukaan diet dari pasien. Anjurkan pilihan makanan tinggi protein dan vitamin C.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan kerjasama pasien dengan aturan diet. Protein/vitamin C adalah kontributor utuma untuk pemeliharaan jaringan dan perbaikan. Malnutrisi adalah fator dalam menurunkan pertahanan terhadap infeksi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi terhadap terjadinya diare; makanan bau busuk dan berminyak.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: </span></i><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sindrom malabsorbsi dapat terjadi setelah pembedahan usus halus, memerlukan evaluasi lanjut dan perubahan diet, mis: diet rendah serat.</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: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan obat-obatan sesuai indikasi: Antimetik, mis: proklorperazin (Compazine). Antasida dan inhibitor histamin, mis: simetidin (tagamet). </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional: </span></i><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencegah muntah. Menetralkan atau menurunkan pembentukan asam untuk mencegah erosi mukosa dan kemungkinan ulserasi.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurang pengetahuan tentang kondisi/situasi, prognosi dan kebutuhan pengobatan b/d kurangnya pemanjanan/mengingat, kesalahan interpretasi informasi, tidak mengenal sumber informasi, keterbatasan kognitif.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Menyatakan paham terhadap proses penyakitnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria hasil</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> :<span> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien dan keluarga mengetahui penyakit yang diderita<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien dan keluarga berpartisipasi dalam proses belajar<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien dan keluarga berpartisipasi dalam proses pengobatan<span> </span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 42.55pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diskusikan pentingnya masukan cairan adekuat dan kebutuhan diet.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Meningkatkan penyembuhan dan normalisasi fungsi usus.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinjau ulang perawatan selang gastrostomi bila pasien dipulangkan dengan alat ini.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional</span></i></b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan kemandirian dan meningkatkan kemampuan perawatan diri.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinjau perawatan kulit disekitar selang.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Membantu mencegah kerusakan kulit dan menurunkan resiko infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi tanda dan gejala yang memerlukan evaluasi medis, mis demam menetap, bengkak, eritema, atau terbukanya tepi luka, perubahan karakteristik drainase.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pengenalan dini dari komplikasi dan intervensi segera dapat mencegah progresi situasi serius dan mengancam hidup.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinjau ulang keterbatasan/pembatasan aktivitas, mis: tidak mengangkat benda berat selama 6-8 minggu dan menghindari latihan dan olahraga keras.</span></div><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Rasional:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> Menurunkan resiko pembentukan hernia.</span><br />
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<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAFTAR PUSTAKA</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Doengoes, Marilynn E. 2000. <i>Rencana Asuhan Keperawatan : Pedoman untuk Perencanaan dan Pendokumentasian Perawatan pasien</i>. Jakarta : Penerbit Buku Kedokteran, EGC.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Muttaqin, Arif. 2009. <i>Asuhan Keperawatan Klien Dengan Gangguan System Kardiovaskular dan Hematologi</i>. Jakarta : Salemba Medika.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Brunner & Suddarth. 2002. <i>Buku Ajar : Keperawatan Medikal Bedah</i>.<span> </span>Jakarta : EGC.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Setiawan, Wawan. 2010. <i>Intervensi dan Rasional Ileus Obstruktif</i>. (</span><a href="http://wawanjokamblog.blogspot.com/"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://wawanjokamblog.blogspot.com/</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Diakses tanggal 11 Januari 2011).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Zwani. 2007. <i>Asuhan Keperawatan Pada Pasien dengan Obstruksi Usus</i> (</span><a href="http://keperawatan-gun.blogspot.com/2007/07/obstruksi-usus.html"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://keperawatan-gun.blogspot.com/2007/07/obstruksi-usus.html</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Diakses tanggal 11 Januari 2011).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Harnawati. 2008. Obstruksi Usus. (</span><a href="http://harnawatiaj.wordpress.com/2008/02/21/obstruksi-usus/"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://harnawatiaj.wordpress.com/2008/02/21/obstruksi-usus/</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Diakses tanggal 11 Januari 2011).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1cm; text-indent: -1cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Vanilow, Barry. 2010. </span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Askep Ileus Obstruksi</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> . (</span><a href="http://barryvanilow.blogspot.com/"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">http://barryvanilow.blogspot.com/</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Diakses tanggal 11 Januari 2011).</span></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com2tag:blogger.com,1999:blog-2695819362399801347.post-72836218626343595032011-02-18T16:42:00.000-08:002011-02-18T16:42:43.056-08:00Askep Sirosis Hepatis<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar <span> </span>Belakang</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Para ahli melaporkan, bahwa minum secangkir kopi setiap hari dapat mengurangi risiko terjadinya sirosis hepatis akibat mengkonsumsi alkohol hingga 22%. Laporan ini disampaikan oleh Kaiser Permanente Medical Care Program, Oakland, California dimana mereka telah mempelajari data 125.580 pasien.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Data-data tersebut didukung oleh hipotesis yang mengatakan bahwa kandungan dari kopi tersebut dapat melindungi hati atau melawan terjadinya sirosis, khususnya sirosis akibat alkohol. Meski demikian apa yang menyebabkan adanya perlindungan terhadap hati tidak diketahui, mereka mengatakan. Kopi mengandung berbagai kumpulan bahan biologikal aktif, para ahli tersebut menjelaskan. Seringkali pula pada kopi tersebut ditambahkan krim, susu dan gula atau substansi lain yang kemungkinan besar memiliki efek kesehatan yang tinggi.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ahli lain mengatakan bahwa kandungan cafein yang terdapat pada kopi yang memiliki peranan sebagai bahan protektif terhadap hati, meski demikian efek protektif tersebut tidak ditemukan pada mereka yang rutin mengkonsumsi teh. Bila benar efek protektif terhadap hati dapat diperoleh dari kopi, risiko peningkatan terjadinya sirosis akibat alkohol dapat ditekan dengan cara yang mudah. Namun sampai saat ini masih dilakukan penelitian yang lebih besar lagi untuk mengetahui kandungan apa yang memiliki efek protektif terhadap hati tersebut.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sekarang, kita bertanya, Apa sih Sirosis Hepatis itu?? Dengan melihat dari uraian latar belakang diatas, maka penulis tertarik menulis makalah yang berjudul, <i>Sirosis Hepatis </i>disertai dengan Asuhan Keperawatannya.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rumusan Masalah</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berdasarkan uraian pada latar belakang diatas maka masalah yang dapat dirumuskan adalah sebagai berikut :</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa pengertian dari Meconium Sirosi Hepatis ?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana Etiologi dari Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana patofisiologi dari Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana manifestasi klinis dari Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa komplikasi dari Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana pemeriksaan diagnostik dari Sirosi Hepatis ?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana terapi / penatalaksanaan dari Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> asuhan keperawatan pada klien dengan </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosi Hepatis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">?</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Penulisan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Umum</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui konsep penyakit yang berhubungan dengan Sirosis Hepatis seta</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asuhan Keperawatan Sirosis Hepatis.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Khusus</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui pengertian dari Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui Etiologi dari Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui patofisiologi Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui manifestasi klinis Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui komplikasi dari Meconium Aspiration Syndrom?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui pemeriksaan diagnostik dari Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui terapi / penatalaksanaan dari <span> </span>Sirosi Hepatis?</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui asuhan keperawatan dari Meconium Aspiration Syndrom?</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 63.8pt; text-indent: 0cm;"><br />
</div><div align="center" class="MsoListParagraphCxSpFirst" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">SIROSIS HEPATIS</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengertian</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis hepatis adalah penyakit hati menahun yang ditandai dengan adanya pembentukan jaringan ikat disertai nodul. Biasanya dimulai dengan adanya proses peradangan nekrosis sel hati yang luas, pembentukan jaringan ikat dan usaha regenerasi nodul. Distorsi arsitektur hati akan menimbulkan perubahan sirkulasi mikro dan makro menjadi tidak teratur akibat penambahan jaringan ikat dan nodul tersebut (Suzanne C. Smeltzer dan Brenda G. Bare, 2001).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="left" class="MsoNormal" style="margin-left: 21.3pt; text-align: left; text-indent: 0cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada 3 tipe sirosis hepatis :</span></div><div align="left" class="MsoListParagraphCxSpFirst" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis portal laennec (alkoholik nutrisional), dimana jaringan parut secara khas mengelilingi daerah portal. Sering disebabkan oleh alkoholis kronis.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis pasca nekrotik, dimana terdapat pita jaringan parut yang lebar sebagai akibat lanjut dari hepatitis virus akut yang terjadi sebelumnya.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis bilier, dimana pembentukan jaringan parut terjadi dalam hati di sekitar saluran empedu. Terjadi akibat obstruksi bilier yang kronis dan infeksi (kolangitis).</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patofisiologi</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Konsumsi minuman beralkohol dianggap sebagai faktor penyebab yang utama. Sirosis terjadi paling tinggi pada peminum minuman keras. Meskipun defisiensi gizi dengan penurunan asupan protein turut menimbulkan kerusakan hati pada sirosis, namun asupan alkohol yang berlebihan merupakan faktor penyebab utama pada perlemakan hati dan konsekuensi yang ditimbulkannya. Namun demikian, sirosis juga pernah terjadi pada individu yang tidak memiliki kebiasan minum dan pada individu yang dietnya normal tapi dengan konsumsi alkohol yang tinggi.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor lain diantaranya termasuk pajanan dengan zat kimia tertentu (karbon tetraklorida, naftalen, terklorinasi, arsen atau fosfor) atau infeksi skistosomiastis dua kali lebih banyak daripada wanita dan mayoritas pasien sirosis berusia 40 – 60 tahun.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span class="fullpost"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis laennec merupakan penyakit yang ditandai oleh nekrosis yang melibatkan sel-sel hati dan kadang-kadang berulang selama perjalanan penyakit sel-sel hati yang dihancurkan itu secara berangsur-angsur digantikan oleh jaringan parut yang melampaui jumlah jaringan hati yang masih berfungsi. Pulau-pulau jaringan normal yang masih tersisa dan jaringan hati hasil regenerasi dapat menonjal dari bagian-bagian yang berkonstriksi sehingga hati yang sirotik memperlihatkan gambaran mirip paku sol sepatu berkepala besar (hobnail appearance) yang khas.Sirosis hepatis biasanya memiliki awitan yang insidus dan perjalanan penyakit yang sangat panjang sehingga kadang-kadang melewati rentang waktu 30 tahun/lebih.</span></span><span class="fullpost"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi Klinis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit ini mencakup gejala ikterus dan febris yang intermiten.<br />
Pembesaran hati. Pada awal perjalanan sirosis, hati cenderung membesar dan sel-selnya dipenuhi oleh lemak. Hati tersebut menjadi keras dan memiliki tepi tajam yang dapat diketahui melalui palpasi. Nyeri abdomen dapat terjadi sebagai akibat dari pembesaran hati yang cepat dan baru saja terjadi sehingga mengakibatkan regangan pada selubung fibrosa hati (kapsula Glissoni). Pada perjalanan penyakit yang lebih lanjut, ukuran hati akan berkurang setelah jaringan parut menyebabkan pengerutan jaringan hati. Apabila dapat dipalpasi, permukaan hati akan teraba benjol-benjol</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(noduler).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi Portal dan Asites. Manifestasi lanjut sebagian disebabkan oleh kegagalan fungsi hati yang kronis dan sebagian lagi oleh obstruksi sirkulasi portal. Semua darah dari organ-organ digestif praktis akan berkumpul dalam vena portal dan dibawa ke hati. Karena hati yang sirotik tidak memungkinkan pelintasan darah yang bebas, maka aliran darah tersebut akan kembali ke dalam limpa dan traktus gastrointestinal dengan konsekuensi bahwa organ-organ ini menjadi tempat kongesti pasif yang kronis; dengan kata lain, kedua organ tersebut akan dipenuhi oleh darah dan dengan demikian tidak dapat bekerja dengan baik. Pasien dengan keadaan semacam ini cenderung menderita dispepsia kronis atau diare. Berat badan pasien secara berangsur-angsur</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mengalami</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penurunan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cairan yang kaya protein dan menumpuk di rongga peritoneal akan menyebabkan asites. Hal ini ditunjukkan melalui perfusi akan adanya shifting dullness atau gelombang cairan. Splenomegali juga terjadi. Jaring-jaring telangiektasis, atau dilatasi arteri superfisial menyebabkan jaring berwarna biru kemerahan, yang sering dapat dilihat melalui inspeksi terhadap wajah dan keseluruhan<span> </span>tubuh.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Varises Gastrointestinal. Obstruksi aliran darah lewat hati yang terjadi akibat perubahan fibrofik juga mengakibatkan pembentukan pembuluh darah kolateral sistem gastrointestinal dan pemintasan (shunting) darah dari pernbuluh portal ke dalam pernbuluh darah dengan tekanan yang lebih rendah. Sebagai akibatnya, penderita sirosis sering memperlihatkan distensi pembuluh darah abdomen yang mencolok serta terlihat pada inspeksi abdomen (kaput medusae), dan distensi pembuluh darah di seluruh traktus gastrointestinal. Esofagus, lambung dan rektum bagian bawah merupakan daerah yang sering mengalami pembentukan pembuluh darah kolateral. Distensi pembuluh darah ini akan membentuk varises atau temoroid tergantung pada lokasinya. Karena fungsinya bukan untuk menanggung volume darah dan tekanan yang tinggi akibat sirosis, maka pembuluh darah ini dapat mengalami ruptur dan menimbulkan perdarahan. Karena itu, pengkajian harus mencakup observasi untuk mengetahui perdarahan yang nyata dan tersembunyi dari traktus gastrointestinal. Kurang lebih 25% pasien akan mengalami hematemesis ringan; sisanya akan mengalami hemoragi masif dari ruptur varises pada lambung dan<span> </span>esofagus.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Edema Gejala lanjut lainnya pada sirosis hepatis ditimbulkan oleh gagal hati yang kronis. Konsentrasi albumin plasma menurun sehingga menjadi predisposisi untuk terjadinya edema. Produksi aldosteron yang berlebihan akan menyebabkan retensi natrium serta air dan ekskresi kalium. Defisiensi Vitamin dan Anemia. Karena pembentukan, penggunaan dan penyimpanan vitamin tertentu yan tidak memadai (terutama vitamin A, C dan K), maka tanda-tanda defisiensi vitamin tersebut sering dijumpai, khususnya sebagai fenomena hemoragik yang berkaitan dengan defisiensi vitamin K. Gastritis kronis dan gangguan fungsi gastrointestinal bersama-sama asupan diet yang tidak adekuat dan gangguan fungsi hati turut menimbulkan anemia yang sering menyertai sirosis hepatis. Gejala anemia dan status nutrisi serta kesehatan pasien yang buruk akan mengakibatkan kelelahan hebat yang mengganggu kemampuan untuk melakukan aktivitas rutinsehari-hari.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kemunduran Mental. Manifestasi klinik lainnya adalah kemunduran fungsi mental dengan ensefalopati dan koma hepatik yang membakat. Karena itu, pemeriksaan neurologi perlu dilakukan pada sirosis hepatis dan mencakup perilaku umum pasien, kemampuan kognitif, orientasi terhadap waktu serta tempat, dan pola bicara.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hematemesis melena</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Koma hepatikum</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpLast" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Diagnostik</span></b></div><div align="left" class="MsoNormal" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada Darah dijumpai HB rendah, anemia normokrom normositer, hipokrom mikrositer / hipokrom makrositer, anemia dapat dari akibat hipersplemisme dengan leukopenia dan trombositopenia, kolesterol darah yang selalu rendah mempunyai prognosis yang kurang baik.</span></div><div align="left" class="MsoNormal" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kenaikan kadar enzim transaminase – SGOT, SGPT bukan merupakan petunjuk berat ringannya kerusakan parenkim hati, kenaikan kadar ini timbul dalam serum akibat kebocoran dari sel yang rusak, pemeriksaan bilirubin, transaminase dan gamma GT tidak meningkat pada sirosis inaktif.</span></div><div align="left" class="MsoNormal" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Albumin akan merendah karena kemampuan sel hati yang berkurang, dan juga globulin yang naik merupakan cerminan daya tahan sel hati yang kurang dan menghadapi stress.</span></div><div align="left" class="MsoNormal" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan CHE (kolinesterase). Ini penting karena bila kadar CHE turun, kemampuan sel hati turun, tapi bila CHE normal / tambah turun akan menunjukan prognasis jelek.</span></div><div align="left" class="MsoNormal" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kadar elektrolit penting dalam penggunaan diuretic dan pembatasan garam dalam diet, bila ensefalopati, kadar Na turun dari 4 meg/L menunjukan kemungkinan telah terjadi sindrom hepatorenal.</span></div><div align="left" class="MsoNormal" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemanjangan masa protrombin merupakan petunjuk adanya penurunan fungsi hati. Pemberian vit K baik untuk menilai kemungkinan perdarahan baik dari varises esophagus, gusi maupun epistaksis.</span></div><div align="left" class="MsoNormal" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peningggian kadar gula darah. Hati tidak mampu membentuk glikogen, bila terus meninggi prognosis jelek.</span></div><div align="left" class="MsoNormal" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan marker serologi seperti virus, HbsAg/HbsAb, HbcAg/ HbcAb, HBV DNA, HCV RNA., untuk menentukan etiologi sirosis hati dan pemeriksaan AFP (alfa feto protein) penting dalam menentukan apakah telah terjadi transpormasi kearah keganasan.</span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terapi / Penatalaksanaan</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Istrahat ditempat tidur sampai terdapat perbaikan ikterus, asites, dan demam.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diet rendah protein. Bila ada asites diberikan diet rendah garam II, dan bila proses tidak aktif, diperlukan diet tinggi protein.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengatasi infeksi dengan antibiotik.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memperbaiki keadaan gizi, bila perlu dengan pemberian asam amino essensial berantai cabang dan glukosa.</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Roboansia. Vitamin B kompleks. Dilarang makan dan minum bahan yang mengandung alkohol.</span></div><div class="MsoNormal" style="margin-left: 0cm; text-indent: 0cm;"><br />
</div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ASUHAN KEPERAWATAN</span></b></div><div align="center" class="MsoNormal" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">SIROSIS HEPATIS</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; text-align: left; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGKAJIAN</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identitas klien</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama lengkap</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suku</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Agama</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanggal lahir</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat Kesehatan Sekarang</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengapa pasien masuk Rumah Sakit dan apa keluahan utama pasien, sehingga dapat ditegakkan prioritas masalah keperawatan yang dapat muncul.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat Kesehatan Sebelumnya</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apakah pasien pernah dirawat dengan penyakit yang sama atau penyakit lain yang berhubungan dengan penyakit hati, sehingga menyebabkan penyakit Sirosis hepatis. Apakah pernah sebagai pengguna alkohol dalam jangka waktu yang lama disamping asupan makanan dan perubahan dalam status jasmani serta rohani pasien.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat Kesehatan Keluarga</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adakah penyakit-penyakit yang dalam keluarga sehingga membawa dampak berat pada keadaan atau yang menyebabkan Sirosis hepatis, seperti keadaan sakit DM, hipertensi, ginjal yang ada dalam keluarga. Hal ini penting dilakukan bila ada gejala-gejala yang memang bawaan dari keluarga pasien.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat Tumbuh Kembang</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan-kelainan fisik atau kematangan dari perkembangan dan pertumbuhan seseorang yang dapat mempengaruhi keadaan penyakit, seperti ada riwayat pernah icterus saat lahir yang lama, atau lahir premature, kelengkapan imunisasi, pada form yang tersedia tidak terdapat isian yang berkaitan dengan riwayat tumbuh kembang.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat Sosial Ekonomi</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apakah pasien suka berkumpul dengan orang-orang sekitar yang pernah mengalami penyakit hepatitis, berkumpul dengan orang-orang yang dampaknya mempengaruhi perilaku pasien yaitu peminum alcohol, karena keadaan lingkungan sekitar yang tidak sehat.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat Psikologi</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana pasien menghadapi penyakitnya saat ini apakah pasien dapat menerima, ada tekanan psikologis berhubungan dengan sakitnya. Kita kaji tingkah laku dan kepribadian, karena pada pasien dengan sirosis hepatis dimungkinkan terjadi perubahan tingkah laku dan kepribadian, emosi labil, menarik diri, dan depresi. Fatique dan letargi dapat muncul akibat perasaan pasien akan sakitnya. Dapat juga terjadi gangguan body image akibat dari edema, gangguan integument, dan terpasangnya alat-alat invasive (seperti infuse, kateter). Terjadinya perubahan gaya hidup, perubaha peran dan tanggungjawab keluarga, dan perubahan status financial (Lewis, Heitkemper, & Dirksen, 2000).</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Fisik </span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesadaran dan keadaan umum pasien<br />
Perlu dikaji tingkat kesadaran pasien dari sadar – tidak sadar (composmentis – coma) untuk mengetahui berat ringannya prognosis penyakit pasien, kekacuan fungsi dari hepar salah satunya membawa dampak yang tidak langsung terhadap penurunan kesadaran, salah satunya dengan adanya anemia menyebabkan pasokan O2 ke jaringan kurang termasuk pada otak.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tanda – tanda vital dan pemeriksaan fisik Kepala – kaki<br />
TD, Nadi, Respirasi, Temperatur yang merupakan tolak ukur dari keadaan umum pasien / kondisi pasien dan termasuk pemeriksaan dari kepala sampai kaki dan lebih focus pada pemeriksaan organ seperti hati, abdomen, limpa dengan menggunakan prinsip-prinsip inspeksi, auskultasi, palpasi, perkusi), disamping itu juga penimbangan BB dan pengukuran tinggi badan dan LLA untuk mengetahui adanya penambahan BB karena retreksi cairan dalam tubuh disamping juga untuk menentukan tingakat gangguan nutrisi yanag terjadi, sehingga dapat dihitung kebutuhan Nutrisi yang dibutuhkan. </span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 3cm; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hati : perkiraan besar hati, bila ditemukan hati membesar tanda awal adanya cirosis hepatis, tapi bila hati mengecil prognosis kurang baik, konsistensi biasanya kenyal / firm, pinggir hati tumpul dan ada nyeri tekan pada perabaan hati. Sedangkan pada pasien Tn.MS ditemukan adanya pembesaran walaupun minimal (USG hepar). Dan menunjukkan sirosis hati dengan hipertensi portal.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 3cm; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Limpa: ada pembesaran limpa, dapat diukur dengan 2 cara :</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 106.35pt; text-align: left; text-indent: -21.3pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Schuffner, hati membesar ke medial dan ke bawah menuju umbilicus (S-I-IV) dan dari umbilicus ke SIAS kanan (S V-VIII)</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 106.35pt; text-align: left; text-indent: -21.3pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hacket, bila limpa membesar ke arah bawah saja.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 3cm; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada abdomen dan ekstra abdomen dapat diperhatikan adanya vena kolateral dan acites, manifestasi diluar perut: perhatikan adanya spinder nevi pada tubuh bagian atas, bahu, leher, dada, pinggang, caput medussae dan tubuh bagian bawah, perlunya diperhatikan adanya eritema palmaris, ginekomastia dan atropi testis pada pria, bias juga ditemukan hemoroid.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DIAGNOSA KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan status nutrisi, kurang dari kebutuhan tubuh berhubungan dengan anoreksia dan gangguan gastrointestinal.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intoleransi aktivitas berhubungan dengan kelelahan dan penurunan berat badan.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan integritas kulit berhubungan dengan pembentukan edema.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">INTERVENSI KEPERAWATAN</span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan 1 :</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Perubahan status nutrisi, kurang dari kebutuhan tubuh berhubungan dengan intake yang tidak adekuat (anoreksia, nausea, vomitus)<br />
Tujuan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Status nutrisi baik<br />
Intervensi :</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji intake diet, Ukur pemasukan diit, timbang BB tiap minggu.<br />
<i>Rasional:</i> Membantu dalam mengidentifikasi defisiensi dan kebutuhan diet. Kondisi fisik umum, gejala uremik (mual, muntah, anoreksia, dan ganggguan rasa) dan pembatasan diet dapat mempengaruhi intake makanan, setiap kebutuhan nutrisi diperhitungan dengan tepat agar kebutuhan sesuai dengan kondisi pasien, BB ditimbang untuk mengetahui penambahan dan penuruanan BB secara periodik.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan makanan sedikit dan sering sesuai dengan diet.<br />
<i>Rasional:</i> Meminimalkan anoreksia dan mual sehubungan dengan status uremik.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tawarkan perawatan mulut (berkumur/gosok gigi) dengan larutan asetat 25 % sebelum makan. Berikan permen karet, penyegar mulut diantara makan.<br />
<i>Rasional:</i> Membran mukosa menjadi kering dan pecah. Perawatan mulut menyejukkan, dan membantu menyegarkan rasa mulut, yang sering tidak nyaman pada uremia dan pembatasan oral. Pencucian dengan asam asetat membantu menetralkan ammonia yang dibentuk oleh perubahan urea (Black, & Hawk, 2005).</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi makanan yang disukai termasuk kebutuhan kultural.<br />
<i>Rasional:</i> Jika makanan yang disukai pasien dapat dimasukkan dalam perencanaan makan, maka dapat meningkatkan nafsu makan pasien.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Motivasi pasien untuk menghabiskan diet, anjurkan makan-makanan lunak.<br />
<i>Rasional:</i> Membantu proses pencernaan dan mudah dalam penyerapan makanan, karena pasien mengalami gangguan sistem pencernaan.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan bahan penganti garam pengganti garam yang tidak mengandung amonium.<br />
<i>Rasional:</i> Garam dapat meningkatkan tingkat absorsi dan retensi cairan, sehingga perlu mencari alternatif penganti garam yang tepat.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan diet 1700 kkal (sesuai terapi) dengan tinggi serat dan tinggi karbohidrat.<br />
<i>Rasional:</i> Pengendalian asupan kalori total untuk mencapai dan mempertahankan berat badan sesuai dan pengendalian kadar glukosa darah</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>h.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan obat sesuai dengan indikasi : Tambahan vitamin, thiamin, besi, asam folat dan Enzim pencernaan.<br />
<i>Rasional:</i> Hati yang rusak tidak dapat menyimpan Vitamin A, B kompleks, D dan K, juga terjadi kekurangan besi dan asam folat yang menimbulkan anemia. Dan Meningkatkan pencernaan lemak dan dapat menurunkan diare.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi pemberian antiemetik<br />
<i>Rasional:</i> untuk menghilangkan mual / muntah dan dapat meningkatkan pemasukan oral</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan 2 :</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Intoleransi aktivitas berhubungan dengan kelelahan dan penurunan berat badan.<br />
Tujua</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">n<span> </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">: Peningkatan energi dan partisipasi dalam aktivitas.<br />
Intervensi :</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tawarkan diet tinggi kalori, tinggi protein (TKTP).<br />
<i>Rasional :</i> Memberikan kalori bagi tenaga dan protein bagi proses penyembuhan.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan suplemen vitamin (A, B kompleks, C dan K)<br />
<i>Rasional :</i> Memberikan nutrien tambahan.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Motivasi pasien untuk melakukan latihan yang diselingi istirahat<br />
<i>Rasional :</i> Menghemat tenaga pasien sambil mendorong pasien untuk melakukan latihan dalam batas toleransi pasien.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Motivasi dan bantu pasien untuk melakukan latihan dengan periode waktu yang ditingkatkan secara bertahap.<br />
<i>Rasional :</i> Memperbaiki perasaan sehat secara umum dan percaya diri.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan 3 :</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Gangguan integritas kulit berhubungan dengan pembentukan edema.<br />
Tujuan <span> </span>: Integritas kulit baik<br />
Intervensi :</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Batasi natrium seperti yang diresepkan.<br />
<i>Rasional :</i> Meminimalkan pembentukan edema.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan perhatian dan perawatan yang cermat pada kulit.<br />
<i>Rasional :</i> Jaringan dan kulit yang edematus mengganggu suplai nutrien dan sangat rentan terhadap tekanan serta trauma.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ubah posisi tidur pasien dengan sering.<br />
<i>Rasional :</i> Meminimalkan tekanan yang lama dan meningkatkan mobilisasi edema.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Timbang berat badan dan catat asupan serta haluaran cairan setiap hari.<br />
<i>Rasional :</i> Memungkinkan perkiraan status cairan dan pemantauan terhadap adanya retensi serta kehilangan cairan dengan cara yang paling baik</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan latihan gerak secara pasif, tinggikan ekstremitas edematus.<br />
<i>Rasional :</i> Meningkatkan mobilisasi edema.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Letakkan bantalan busa yang kecil dibawah tumit, maleolus dan tonjolan tulang lainnya.<br />
<i>Rasional :</i> Melindungi tonjolan tulang dan meminimalkan trauma jika dilakukan dengan benar.</span></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoListParagraphCxSpFirst" style="margin-left: 0cm; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB IV</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENUTUP</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-align: left; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesimpulan</span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-align: left; text-indent: 21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis hepatis adalah penyakit hati menahun yang ditandai dengan adanya pembentukan jaringan ikat disertai nodul. Biasanya dimulai dengan adanya proses peradangan nekrosis sel hati yang luas, pembentukan jaringan ikat dan usaha regenerasi nodul. Distorsi arsitektur hati akan menimbulkan perubahan sirkulasi mikro dan makro menjadi tidak teratur akibat penambahan jaringan ikat dan nodul tersebut </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-align: left; text-indent: 0cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada 3 tipe sirosis hepatis :</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis portal laennec (alkoholik nutrisional), dimana jaringan parut secara khas mengelilingi daerah portal. Sering disebabkan oleh alkoholis kronis.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis pasca nekrotik, dimana terdapat pita jaringan parut yang lebar sebagai akibat lanjut dari hepatitis virus akut yang terjadi sebelumnya.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sirosis bilier, dimana pembentukan jaringan parut terjadi dalam hati di sekitar saluran empedu. Terjadi akibat obstruksi bilier yang kronis dan infeksi (kolangitis).</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-align: left; text-indent: 0cm;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalkasanaan sirosis hepatis adalah :</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Istrahat ditempat tidur sampai terdapat perbaikan ikterus, asites, dan demam.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diet rendah protein. Bila ada asites diberikan diet rendah garam II, dan bila proses tidak aktif, diperlukan diet tinggi protein.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengatasi infeksi dengan antibiotik.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memperbaiki keadaan gizi, bila perlu dengan pemberian asam amino essensial berantai cabang dan glukosa.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-align: left; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Roboansia. Vitamin B kompleks. Dilarang makan dan minum bahan yang mengandung alkohol.</span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; text-align: left; text-indent: -21.3pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saran</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagi para pembaca (mahasiswa) diharapkan dapat memetik pemahaman dari uraian yang dipaparkan diatas yaitu <i>Sirosis Hepatis</i>, dan dapat mengaplikasikannya dalam lingkungan masyarkat khususnya dalam pemberian penyuluhan untuk pencegahan/ atau pengurangan faktor predisposisi sirosis hepatis tersebut.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagi mahasiswa, diharapkan agar terus menambah wawasan khususnya dalam bidang keperawatan.</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagi dosen pembimbing, diharapkan dapat memberi masukan, baik dalam proses penyusunan maupun dalam pemenuhan referensi untuk membantu kelancaran dan kesempurnaan pembuatan makalah kedepannya.</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 42.55pt; text-indent: -21.25pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">DAFTAR PUSTAKA</span></b></div><div class="MsoNormal" style="line-height: 150%;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Danis, Difa<i>. Kamus Istilah Kedokteran.</i> Gitamedia Press</span></div><div class="MsoNormal" style="line-height: 150%;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Doenges, E Marilynn.1999. <i>Rencana Asuhan Keperawatan</i>. Jakarta : EGC</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; text-indent: -21.3pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mansjoer, Arief. 2000. <i>Kapita Selekta Kedokteran, Edisi ketiga, Jilid 2</i>. Jakarta: Media Aesculaplus.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 21.3pt; text-indent: -21.3pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Posted by : Hidayat2, pada Mei/ 12/ 2009. <i>Askep Sirosis Hepatis</i>. (Diakses tanggal 8 januari 2011).</span></div><div class="MsoNormal" style="line-height: 150%;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">www. google. com/ <i>infeksi peurpuralis</i>, (online). (Diakses tanggal 6 januari 2011).</span></div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>YAYA HASGURhttp://www.blogger.com/profile/00817506266709767627noreply@blogger.com0