Pp 6 Panduan Manajemen Nyeri Hpk PDF

PANDUAN

PANDUAN

MANAJEMEN NYER I

MANAJEMEN NYER I

RS PKU MUHAMMADI

RS PKU MUHAMMADI

 Y

 Y

AH Y

AH Y

OG Y

OG Y

AKAR

AKAR

T

T

A

A

UNIT II

UNIT II

RS PKU Muhamm

RS PKU Muhamm Jl.Wate Jl.WatediyahdiyahsKMsKM Y Yogyakarogyakartata5,5Gampin,5,5Gampin,untuntIIIISleman, Y!"a#a$ta%Sleman, Y!"a#a$ta%

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RS PKU MUHAMMADIYAH YOGYAKARTA UNIT II

RS PKU MUHAMMADIYAH YOGYAKARTA UNIT II

Jl.Wates Km 5,5 Gamping, Sleman, Yogyakarta – 55294

Jl.Wates Km 5,5 Gamping, Sleman, Yogyakarta – 55294

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SAKIT PKU MUHAMMADIYAH YOGYAKARTA UNIT II SAKIT PKU MUHAMMADIYAH YOGYAKARTA UNIT II

 Nomor : 0432./PS.

 Nomor : 0432./PS.1.2/IV/20151.2/IV/2015 Tentang

Tentang

PANDUAN MANAJEMEN NYEI PANDUAN MANAJEMEN NYEI

DIE!TU UMA" SA!IT P!U MU"AMMADIYA" Y#$YA!ATA UNIT II DIE!TU UMA" SA!IT P!U MU"AMMADIYA" Y#$YA!ATA UNIT II

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M,(amma*%a( Yogaarta Un%t II.  &.

 &. 'a()a e,a% &,t%r 'a()a e,a% &,t%r a *%ata a *%ata -er+, meneta-an !e-,t,an-er+, meneta-an !e-,t,an D%ret,r ,ma( Sa%t P!U M,(amma*%a( Yogaarta D%ret,r ,ma( Sa%t P!U M,(amma*%a( Yogaarta Un%t II tentang

Un%t II tentang Pan*,an Manaemen Ner%Pan*,an Manaemen Ner% M

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!ee(atan 2.

2. Un*angUn*ang I NomUn*angUn*ang I Nomor 44 Tor 44 Ta(,n 200 tentanga(,n 200 tentang ,ma( Sa%t

,ma( Sa%t 3.

3. Un*angUn*ang I NomUn*angUn*ang I Nomor 2 Tor 2 Ta(,n 2004 tentanga(,n 2004 tentang Prate !e*oteran

Prate !e*oteran 4

4. !. !ee--,,tt,,aann MMeenntteerr%% !eeee(! (aattaann II NNoommoor  r   115.A/M

115.A/Men!e/S!/6/2004 tentang en!e/S!/6/2004 tentang !om%% Are*%ta%!om%% Are*%ta% ,ma( Sa%t.

,ma( Sa%t. 5.

5. S,rat !e-,t,an S,rat !e-,t,an 'a*an Pe+a'a*an Pe+aana "ar%an ,mana "ar%an ,ma( Sa%ta( Sa%t P!U M,(amma*%a( Yogaarta nomer 015/'II/'P" P!U M,(amma*%a( Yogaarta nomer 015/'II/'P" II/6II/2013 tangga+ 12 Deem&er 2013 M tentang II/6II/2013 tangga+ 12 Deem&er 2013 M tentang S,,nan D%re% ,ma( Sa%t P!U M,(amma*%a( S,,nan D%re% ,ma( Sa%t P!U M,(amma*%a( Y

Yogogaaaartrtaa UnUn%t I%t II.I.

RS PKU Muhammadiyah Yogyakarta unit

M E M U T U S K A N M E M U T U S K A N

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Meenneettaa--aann ::

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TEENNTTAANN$$ PPAANNDDUUAANN MMAANNAAJJEEMMEENNNNYYEEII 

UUMMAA"" SSAA!!IITT PP!!UU MMUU""AAMMMMAADDIIYYAA"" Y#$YA!ATA UNIT II.

Y#$YA!ATA UNIT II. !

!EEDDUUAA :: PPaann**,,aan n MMaannaaeemmeenn NNeerr%% **%%mmaa,,**aan n ee&&aaggaa%%mmaannaa ter7ant,m *a+am Pan*,an *% !e-,t,an %n%.

ter7ant,m *a+am Pan*,an *% !e-,t,an %n%. !

!EETTII$$AA :: PPee++aaaannaaaann PPaann**,,aann MMaannaaeemmeenn NNeerr%% **%%mmaa,,**aann ,nt, men%ngatan ,a+%ta *an eamanan -e+aanan ,nt, men%ngatan ,a+%ta *an eamanan -e+aanan  -a%en e&aga%mana *

 -a%en e&aga%mana *%ma,* *a+am D%t,m e%ma,* *a+am D%t,m eat,at, !

!EEEEMMPPAATT :: !!ee--,,tt,,aan n %%nn% % &&eerr++aa, , eeaa  ttaannggggaa+ + **%%tteettaa--aann.. D%teta-an *% : S+eman D%teta-an *% : S+eman

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RS PKU Muhammadiyah Yogyakarta unit

!ATA PEN$ANTA  !ATA PEN$ANTA 

Aemen a*a+a( mer,-aan ,at, -roe ang *%nam% *an &er+ang,ng ter, Aemen a*a+a( mer,-aan ,at, -roe ang *%nam% *an &er+ang,ng ter, mener, *%&er&aga% ea*aan ra)at %na- *an ra)at a+an aemmen -a%en ter*%r% ata mener, *%&er&aga% ea*aan ra)at %na- *an ra)at a+an aemmen -a%en ter*%r% ata t%

t%ga ga -r-rooe e ,t,tamama a aa%t%t, , PePengng,m,m-,-,+a+an n %n%n;o;ormrmaa% % AnAna+a+%%% % %n%n;o;ormrmaa% % *a*ann Pengem&angan ren7ana -era)atan ,nt, memen,(% e&,t,(an -a%en.

Pengem&angan ren7ana -era)atan ,nt, memen,(% e&,t,(an -a%en. A

Aememen en -a-a%e%en n terter*%r*%r% % *ar*ar% % AAememen en a)aa)a+ + *an *an aaememen en ,+a,+ang. Aeng. Aemenmen *%

*%+a+a,,aan n teter(r(a*a*a- a- eem,m,a a -a-a%%en en aang ng *% *% +a+aaan% n% *% *% S S P!P!U U M,M,(a(ammmma*a*%%a(a( Yogaarta Un%t II. Aemen *%+a,an o+e( *oter -era)at *an ta; *%%-+%n +%n% Yogaarta Un%t II. Aemen *%+a,an o+e( *oter -era)at *an ta; *%%-+%n +%n% +a%nna.

+a%nna.

Dengan a*ana -an*,an Aemen Pa%en *%(ara-an *a+am -roe aemen Dengan a*ana -an*,an Aemen Pa%en *%(ara-an *a+am -roe aemen  -a%en

 -a%en *% *% S S P!U P!U M,(amma*%a( YM,(amma*%a( Yogaarta ogaarta Un%t Un%t II II *a-at *a-at e,a% e,a% *engan *engan -an*,an-an*,an ang &er+a, *% S P!U M,(amma*%a( Yogaarta Un%t II. Se(%ngga *engan -roe ang &er+a, *% S P!U M,(amma*%a( Yogaarta Un%t II. Se(%ngga *engan -roe a

aememen en -a-a%en %en anang g e;ee;et%t%; ; aaaan n menmeng(ag(a%+%+an an e-e-,t,,t,an an -e+-e+aaaanan nan tententantangg  -engo&atan -a%en

 -engo&atan -a%en ang e,a% *engaang e,a% *engan e&,t,(an -enn e&,t,(an -engo&atan -a%engo&atan -a%en Unt

Unt, , -en-en%ng%ngatatan an m,tm,t, , -e-e+a+aanaanan n *%-*%-er+er+,a,an n -e-engengem&am&angangan n e&e&%a%aanan  -e*oman -an*,a

 -e*oman -an*,an *an -roe*,rn *an -roe*,r. Unt, t,,an tere&,t -an*,an %n% aa. Unt, t,,an tere&,t -an*,an %n% aan am% e<a+,a%n am% e<a+,a% et%*ana et%a- 2 ta(,n ea+%. Ma,an r%t% *an aran ang ontr,t%; ,nt,  et%*ana et%a- 2 ta(,n ea+%. Ma,an r%t% *an aran ang ontr,t%; ,nt,   -engem&angan -a

 -engem&angan -an*,an %n% angat am% (n*,an %n% angat am% (ara-an *ar% -ara -ara-an *ar% -ara -em&a7a.em&a7a.

S+eman

S+eman 15 15 A-r%+ 2015A-r%+ 2015

D%ret,r  D%ret,r 

RS PKU Muhammadiyah Yogyakarta unit

ISI ii DA8TAISI

"a+: SUAT"A=AMAN!EPUTUSANJUDU= DIE!TU 

!ATA PEN$ANTA  %%

SUAT!EPUTUSANDIE!TU %

DA8TA ISI %%% !ATA PEN$ANTA  %% A. DE8INISI 1 'DA8TA.TUJUANISI   %%%1 >. UAN$=IN$!UP 1 'A' I: PENDA"U=UAN D. TATA =A!SANA ₁ I. =atar 'e+aang II. De;%n%% 1 III. ,ang =%ng,- 1 'A' II: ASESSMEN NYEI

A. Meng,m-,+an In;orma% *an Data 3 '. Ana+%a %n;orma% *an *ata  >. Mem&,at ren7ana -e+aanan ,nt, memen,(% em,a 

e&,t,(an -a%en ang te+a( *%%*ent%;%a%.

D. Sa+a Ner%  E. AemenU+ang 13 'A' VI: MANAJEMEN NYEI

A. Manaemen Ner% A,t 14 '. Manaemen Ner% !ron% 23 >. Manaemen Ner% Pa*a Pe*%atr% 31 D. Manaemen Ner% Pa*a !e+om-o U%a =an,t ?$er%atr%@ 3 'A'VII: D#!UMENTASI 3

!EPUSTA!AAN 3

RS PKU Muhammadiyah Yogyakarta unit II i1

=AMPIAN

!e-,t,an D%ret,r Nomor : 0432 /PS.1.2/IV/2015 Tentang Pan*,an Manaemen Ner%

PANDUAN MANAJEMEN NYEI

I. DE8INISI

 Ner% a*a+a( -enga+aman enor% *an emo%ona+ ang *%a%&atan a*ana er,aan  ar%ngan ang e*ang ata, aan tera*% ata, -enga+aman enor% *an emo%ona+ ang meraaan eo+a(o+a( tera*% er,aan ar%ngan. (International Association for the Study of Pain).

 Ner% a,t a*a+a( ner% *engan onet egera *an *,ra% ang ter&ata mem%+%% (,&,ngan tem-ora+ *an a,a+ *engan a*ana 7e*era ata, -ena%t.

 Ner% ron% a*a+a( ner% ang &erta(an ,nt, -er%o*e )at, ang +ama. Ner% ron%  a*a+a( ner% ang ter, a*a me%-,n te+a( tera*% -roe -enem&,(an *an er%ng ea+% t%*a *%eta(,% -ene&a&na ang -at%.

II. UAN$ =IN$!UP

1. Aemen *an manaemen ner% *%+a,an ,nt, em,a -a%en ra)at a+an ma,-,n ra)at %na- *% ,ma( Sa%t P!U M,(amma*%a( Yogaarta ,n%t II.

2. Aemen *an manaemen ner% %n% *%+a,an o+e( *oter *an -era)at ang om-eten e,a% -er%B%nan ,n*ang,n*ang *an -erat,ran ang &er+a,.

III. ASESMEN NYEI

A. Meng,m-,+an In;orma% *an Data 1. Anamne%

a. !e+,(an Utama

!e+,(an ,tama ner% ertaan *ata +amana e+,(an ner% tere&,t.

 &. %)aat Pena%t Searang

 #net ner% : a,t ata, ron% tra,mat% ata, nontra,mat%.

 !arater *an *eraat e-ara(an ner% : ner% t,m-,+ ner% taam raa

ter&aar t%*a naman eem,tan ne,ra+g%a.

 Po+a -ena+aran/-ene&aran ner%.  D,ra% *an +oa% ner%.

 $ea+a +a%n ang menerta% m%a+na e+ema(an &aa+ eem,tan

m,a+/m,nta( ata, gangg,an ee%m&angan/ontro+ motor%.

 8ator ang mem-er&erat *an mem-er%ngan.  !ron%%ta.

 "a%+ -emer%aan *an -enanganan ner% e&e+,mna terma, re-on

tera-%.

 $angg,an/e(%+angan ;,ng% a%&at ner%/+,a.  Pengg,naan a+at &ant,.

 Per,&a(an ;,ng% mo&%+%ta ogn%t%; %rama t%*,r *an at%<%ta

(%*,-*aar ?activity of daily living @.

 S%ng%ran em,ng%nan -oten% emergen% -em&e*a(an e-ert%

a*ana ;rat,r ang t%*a ta&%+ gea+a ne,ro+og% -rogre%; 7e-at ang  &er(,&,ngan *engan %n*rom a,*a e,%na.

7. %)aat Pena%t Da(,+,

 %)aat -ena%t *a(,+,.  %)aat -em&e*a(an/o-era%.

*. %)aat P%o+og% So%a+ Eonom% ',*aa

 %)aat on,m% a+o(o+ meroo ata, narot%a.  I*ent%;%a% -enga,(/-era)at ,tama ?-r%mer@ -a%en.

 I*ent%;%a% on*%% tem-at t%ngga+ -a%en ang &er-oten% men%m&,+an

eaer&a% ner%.

 Pem&ataan/retr%% -art%%-a% -a%en *a+am at%<%ta o%a+ ang

 &er-oten% men%m&,+an tre. Pert%m&angan ,ga at%<%ta  -enggant%na.

 Maa+a( -%%atr% ?m%a+na *e-re% 7ema %*e %ng%n &,n,( *%r%@ *a-at

men%m&,+an -engar,( negat%; ter(a*a- mot%<a% *an oo-era% -a%en *engan -rogram -enanganan/manaemen ner% e *e-anna. Pa*a  -a%en *engan maa+a( -%%atr% *%-er+,an *,,ngan  -%otera-%/-%o;armaa.

 Peeraan ang me+%&atan geraan &er,+ang *an r,t%n e-ert%

mengangat &en*a &erat mem&,ng, ata, mem,tar mer,-aan  -eeraan terer%ng ang &er(,&,ngan *engan ner% -,ngg,ng.

 T%*a *a-at &eerana -a%en a%&at ner% *a-at men%m&,+an tre

 &ag% -a%en/e+,arga. e. %)aat Pena%t !e+,arga

E<a+,a% r%)aat me*% e+,arga ter,tama -ena%t genet%. ;. %)aat A+erg%

%)aat a+erg% maanan o&at *an a++ergen ang +a%n % a a*a. g. %)aat Pengo&atan

 Da;tar o&ato&atan ang -erna( *an e*ang *%on,m% -a%en ,nt,

meng,rang% ner%.

 >ant,man ,ga mengena% *o% t,,an m%n,m o&at *,ra% e;et%;%ta

*an e;e am-%ng.

 D%reomen*a%an ,nt, meng,rang% ata, mem&er(ent%an o&ato&atan

*engan e;e am-%ng ogn%t%; *an ;%%. (. Aemen %tem organ ang om-re(en%; 

 E<a+,a% gea+a ar*%o<a,+ar -%%atr% -,+moner gatro%ntet%na+

ne,ro+og% re,mato+og% gen%to,r%nar%a en*or%n *an m,,+oe+eta+.

 $ea+a ont%t,%ona+ : -en,r,nan &erat &a*an ner% ma+am (ar%

er%ngat ma+am *an e&aga%na.

2. Pemer%aan 8%%  a. Pemer%aan Um,m

 Tan*a <%ta+ : teanan *ara( na*% -erna-aan ,(, t,&,(.  U,r+a( &erat &a*an *an t%ngg% &a*an -a%en.

 Per%a a-aa( ter*a-at +e%/+,a *% ,+%t e-ert% ar%ngan -ar,t a%&at

o-era% (%-er-%gmenta% ,+era% tan*a &ea ar,m ,nt%.

 Per(at%an ,ga a*ana et%*aegar%an t,+ang ?malalignment @ atro;%

otot ;a%,+a% *%o+ora% *an e*ema.  &. Stat, Menta+

 N%+a% or%enta% -a%en.

 N%+a% emam-,an meng%ngat anga -anang -en*e *an egera.  N%+a% emam-,an ogn%t%;.

 N%+a% on*%% emo%ona+ -a%en terma, gea+agea+a *e-re% t%*a

a*a (ara-an ata, 7ema. 7. Pemer%aan Sen*%

 Se+a+, -er%a e*,a %% ,nt, men%+a% e%metr%an.

 N%+a% *an 7atat -ergeraan at%; em,a en*% -er(at%an a*ana

eter&ataan gera *%%ne% ra,t )aa( mer%ng% ata, a%metr%.

 N%+a% *an 7atat -ergeraan -a%; *ar% en*% ang ter+%(at

a&norma+/*%e+,(an o+e( -a%en ?aat men%+a% -ergeraan at%;@. Per(at%an a*ana +%m%ta% gera ra,t )aa( mer%ng% ata, a%metr%.

 Pa+-a% et%a- en*% ,nt, men%+a% a*ana ner%.

 Pemer%aan ta&%+%ta en*% ,nt, meng%*ent%;%a% a*ana 7e*era

+%gamen.

*. Pemer%aan Motor% 



Nilai dan catat kekuatan

motorik pasien dengan

menggunakan kriteria di bawah

ini :

Deraat De;%n%%

5 T%*a ter*a-at eter&ataan gera mam-, me+a)an ta(anan ,at.

4 Mam-, me+a)an ta(anan r%ngan. 3 Mam-, &ergera me+a)an gra<%ta%.

2 Mam-, &ergera/&ergeer e %r% *an anan teta-% t%*a  mam-, me+a)an gra<%ta%.

1 Ter*a-at ontra% otot ?%n-e%/-a+-a%@ t%*a   meng(a%+an -ergeraan.

0 T%*a ter*a-at ontra% otot. e. Pemer%aan Senor% 

 =a,an -emer%aan : ent,(an r%ngan ner% ?t,,an ar,m C pin

 prick @ getaran *an ,(,. ;. Pemer%aan Ne,ro+og% +a%nna

 E<a+,a% ner<, ran%a+ I C 6II ter,tama %a -a%en menge+,( ner%

)aa( ata, er<%a+ *an a%t e-a+a.



Periksa refleks otot, nilai

adanya asimetris dan klonus.

Untuk mencetuskan klonus

membutuhkan kontraksi > 4

otot.

e;+e Segmen -%na+ '%e- >5 'ra%ora*%a+% > Tr%e- >9 Ten*on-ate++a =4 "amtr%ngme*%a+ =5 A7(%++e S1

  N%+a% a*ana re;+e 'a&%n% *an "o;;man ?(a%+ -o%t%; men,n,an

+e% upper motor neuron@.

  N%+a% gaa &era+an -a%en *an %*ent%;%a% *e;%%t ere&e+,m *engan

me+a,an te *%metr% ?te -ergeraan ar% C e C (%*,ng -ergeraan t,m%t C e C t%&%a@ te *%*%a*oo%ne%a *an te ee%m&angan ?om&erg *an om&erg mo*%;%a%@.

g. Pemer%aan !(,,

 Ter*a-at 5 tan*a nonorgan% -a*a -a%en *engan gea+a ner% teta-%

t%*a *%tem,an et%o+og% e7ara anatom%. Pa*a &e&era-a -a%en *engan 5 tan*a %n% *%tem,an menga+am% (%-oon*r%a% (%ter%a *an *e-re%.

 !e+%ma tan*a %n% a*a+a( :

1@ D%tr%&,% ner% ,-er;%%a+ ata, nonanatom%. 2@ $angg,an enor% ata, motor% nonanatom%. 3@ Ver&a+%a% &er+e&%(an aan ner% ?o<erreat%;@.

4@ ea% ner% ang &er+e&%(an aat mena+an% te/-emer%aan ner%. 5@ !e+,(an aan ner% ang t%*a on%ten ?&er-%n*a(-%n*a(@ aat

geraan ang ama *%+a,an -a*a -o%% ang &er&e*a ?*%tra%@.

3. Pemer%aan E+etrom%ogra;% ?EM$@

a. Mem&ant, men7ar% -ene&a& ner% a,t/ron% -a%en.

 &. Meng%*ent%;%a% area -erara;an/7e*era otot ;oa+ ata, *%;, ang terena. 7. Meng%*ent%;%a% ata, men%ng%ran em,ng%nan ang &er(,&,ngan

*engan re(a&%+%ta% %ne% -em&e*a(an ata, tera-% o&at. *. Mem&ant, menegaan *%agno%.

e. Pemer%aan er%a+ mem&ant, -emanta,an -em,+%(an -a%en *an re-on ter(a*a- tera-%.

;. In*%a% : e7,r%gaan ara; tere-%t mono/-o+%ne,ro-at% ra*%,+o-at%. g. Nam,n -emer%aan %n% &e+,m tere*%a *% S P!U M,(amma*%a(

Yogaarta ,n%t II.

4. Pemer%aan Senor% !,ant%tat%; 

a. Pemer%aan enor% mean% ?t%*a ner%@ : getaran

 &. Pemer%aan enor% mean% ?ner%@ : t,,an ar,m teanan 7. Pemer%aan ena% ,(, ?*%ng%n (angat -ana@

*. Pemer%aan ena% -ere-%

5. Pemer%aan a*%o+og%

a. In*%a% :

 Pa%en ner% *engan e7,r%gaan -ena%t *egenerat%; t,+ang &e+aang.  Pa%en *engan e7,r%gaan a*ana neo-+ama %n;e% t,+ang &e+aang

 -ena%t %n;+amator% *an -ena%t <a7,+ar.

 Pa%en *engan *e;%%t ne,ro+og% motor% o+on an*,ng em%( ata,

ere%.

 Pa%en *engan r%)aat -em&e*a(an t,+ang &e+aang.  $ea+a ner% ang meneta-  4 m%ngg,.

 &. Pem%+%(an -emer%aan ra*%o+og% :

'ergant,ng -a*a +oa% *an arater%t% ner%.

 8oto -o+o : ,nt, r%n%ng %n%%a+ -a*a t,+ang &e+aang ?;rat,r

et%*aegar%an <erte&ra -on*%+o+%te% -on*%+o+%% neo-+ama@.

 MI :  gold standard  *a+am menge<a+,a% t,+ang &e+aang ?(ern%a%

*%, teno% -%na+ oteome+%t% %n;e% r,ang *%, eganaan om-re% t,+ang &e+aang %n;e%@. Nam,n -emer%aan %n% &e+,m tere*%a *% S P!U M,(amma*%a( Yogaarta ,n%t II.

 >T7an : e<a+,a% tra,ma t,+ang &e+aang (ern%a% *%, teno%

-%na+.

 a*%on,+%*a bone-scan  : angat &ag, *a+am men*ete% -er,&a(an

meta&o+%me t,+ang ?men*ete% oteome+%t% *%n% ;rat,r om-re% ang e7%+/m%n%ma+ eganaan -r%mer metata% t,+ang@. Nam,n  -emer%aan %n% &e+,m tere*%a *% S P!U M,(amma*%a( Yogaarta

,n%t II.

. Aemen P%o+og%

a. N%+a% moo* -a%en a-aa( *a+am on*%% 7ema eta,tan *e-re%.  &. N%+a% a*ana gangg,an t%*,r maa+a( tera%t -eeraan.

7. N%+a% a*ana *,,ngan o%a+ %ntera% o%a+. '. Ana+%a %n;orma% *an *ata

Sete+a( *ata om-re(en%; ang ,*a( *%,m-,+an &a% &er,-a *ata ,&et%;  ma,-,n *ata o&et%; maa *%+a,an ana+%a %n;orma% *an *ata. 'ag%an %n% ter*%r% *ar% : -en,+%an r%ngaan -en,,nan *a;tar maa+a( mem&,at -enga%an *ar% ma%ngma%ng maa+a( ?*%agnoa *an *%agnoa &an*%ng@.

>. Mem&,at ren7ana -e+aanan ,nt, memen,(% em,a e&,t,(an -a%en ang te+a( *%%*ent%;%a%.

en7ana -e+aanan me+%-,t% : ren7ana *%agno% ren7ana tera-% ren7ana mon%tor%ng *an ren7ana e*,a%.

D. Sa+a Ner%

In*%ator t,ngga+ ang -a+%ng -ent%ng ,nt, mengeta(,% %nten%ta ner% a*a+a( e+,(an -a%en. Inten%ta ner% mer,-aan gam&aran tentang e&era-a -ara( ner% *%raaan o+e( -a%en -eng,,ran %nten%ta ner% angat ,&et%; maa  -en*eatan o&et%; ang -a+%ng m,ng%n a*a+a( *engan mengg,naan a+a

ner%.

Sa+a ner% ang *%g,naan *% S P!U M,(amma*%a( Yogaarta ,n%t II e&aga%  &er%,t :

1. umeric !ating Scale

In*%a% : *%g,naan -a*a -a%en *e)aa *an ana &er,%a   ta(,n ang *a-at mengg,naan anga ,nt, me+am&angan %nten%ta ner% ang *%raaanna.

Intr,% : -a%en aan *%tana mengena% %nten%ta ner% ang *%raaan *an *%+am&angan *engan anga antara 0 C 10.

0  t%*a ner%

% C 3 ner% r%ngan ?e*%%t menggangg, at%<%ta e(ar%(ar%@

4 C   ner% e*ang ?gangg,an nata ter(a*a- at%<%ta e(ar%(ar%@ 9 C 10  ner% &erat ?t%*a *a-at me+a,an at%<%ta e(ar%(ar%@

 umeric !ating Scale

". #ong $aker %aces Pain Scale

In*%a% : -a*a -a%en ?*e)aa *an ana  3 ta(,n@ ang t%*a *a-at

menggam&aran %nten%ta ner%na *engan anga g,naan aemen. Intr,% : -a%en *%m%nta ,nt, men,n,/mem%+%( gam&ar mana ang -a+%ng e,a% *engan ang %a raaan. Tanaan ,ga +oa% *an *,ra% ner% :

0 C 1 angat &a(ag%a arena t%*a meraa ner% ama ea+% 2 C 3 e*%%t ner%

4 C 5 7,,- ner%  C 9 +,maan ner%  C   angat ner%

10  amat angat ner% ? ta terta(anan @

#ong $aker %aces Pain Scale &. 'omfort Scale

In*%a% : -a%en &a% ana *an *e)aa *% r,ang ra)at %nten%;/amar  o-era%/r,ang ra)at %na- ang t%*a *a-at *%n%+a% mengg,naan  umeric  !ating Scale *an #ong $aker %aces Pain Scale.

Intr,% : ter*a-at  ategor% *engan et%a- ategor% mem%+%% or 1 C 5 *engan or tota+ antara  C 45.

- !e)a-a*aan - !etenangan - D%tre -erna-aan - Menang% - Pergeraan - Ton, otot - Tegangan )aa( - Teanan *ara( &aa+ - Den,t ant,ng &aa+

 Pa*a -a%en *a+am -engar,( o&at anete% ata, *a+am on*%% e*a% e*ang

aemen *an -enanganan ner% *%+a,an aat -a%en men,n,an re-on  &er,-a e-re% t,&,( ata, <er&a+ aan raa ner%.

'omfort Scale

!ategor% Sor   Tangga+ / )at, 1 C t%*,r -,+a/nena 

2 C t%*,r ,rang nena  !e)a-a*aan 3 C ge+%a(

4 C a*ar e-en,(na *an )a-a*a 5 C hiper alert  1 C tenang 2 C aga 7ema !etenangan 3 C 7ema 4 C angat 7ema 5 C -an%7

1 C t%*a a*a re-%ra% -ontan *an t%*a  a*a &at, 

2 C re-%ra% -ontan *engan e*%%t/t%*a  a*a re-on ter(a*a- <ent%+a%

D%tre 3 C a*anga*ang &at, ata, ter*a-at  -erna-aan ta(anan ter(a*a- <ent%+a%

4 C    er%ng  &at, ter*a-at ta(anan/-er+a)anan ter(a*a-<ent%+ator 

5 C me+a)an e7ara at%;

<ent%+ator &at, ter, mener,/tere*a 

1 C &erna-a *engan tenang t%*a  menang%

Menang% 2 C ter%a%a   3 C mera,ng 4 C menang% 5 C &erter%a 

1 C t%*a a*a -ergeraan

2 C e*anga*ang &ergera -er+a(an Pergeraan 3 C er%ng &ergera -er+a(an

4 C -ergeraan at%;/ge+%a(

5 C -ergraan at%; terma, &a*an *an e-a+a

1 C otot re+a e-en,(na t%*a a*a ton, otot

2 C -en,r,nan ton, otot Ton, otot 3 C ton, otot norma+

4 C -en%ngatan ton, otot *an ;+e% ar% tangan *an a%

5 C ea,an otot etr%m *an ;+e% ar% tangan *an a%

1 C otot )aa( re+a e-en,(na

2 C ton, otot )aa( norma+ t%*a   ter+%(at tegangan otot )aa( ang Tegangan nata

3 C tegangan &e&era-a otot )aa( ter+%(at )aa(

nata

4 C tegangan (am-%r *% e+,r,( otot )aa(

5 C e+,r,( otot )aa( tegang mer%ng% 1 C teanan *ara( *% &a)a( &ata norma+ 2 C teanan *ara( &era*a *% &ata norma+

e7ara on%ten

3 C -en%ngatan teanan *ara( eea+% F Teanan *ara( 15G *% ata &ata norma+ ?1 C 3 a+%

*a+am o&er<a% e+ama 2 men%t@  &aa+

4 C er%ngna -en%ngatan teanan *ara( F 15G *% ata &ata norma+ ? 3 a+% *a+am o&er<a% e+ama 2 men%t@

5 C -en%ngatan teanan *ara( ter, mener, F 15G

Den,t ant,ng 1 C *en,t ant,ng *% &a)a( &ata  &aa+ norma+

2 C *en,t ant,ng &era*a *% &ata norma+ e7ara on%ten

3 C -en%ngatan *en,t ant,ng eea+%

≥ 15G *% ata &ata norma+ ?1 C 3 a+%

*a+am o&er<a% e+ama 2 men%t@ 4 C er%ngna -en%ngatan *en,t

 ant,ng F 15G *% ata &ata norma+ ? 3 a+% *a+am o&er<a% e+ama 2 men%t@

5 C -en%ngatan *en,t ant,ng ter, mener, F 15G

Sor tota+

E. Aemen U+ang

Aemen ,+ang *%+a,an -a*a -a%en ang *%ra)at +e&%( *ar% &e&era-a am *an men,n,an a*ana raa ner% e&aga% &er%,t :

1. =a,an aemen ner% ang om-re(en%; et%a- a+% me+a,an ,n,ngan/<%%te e -a%en.

2. D%+a,an -a*a : -a%en ang menge+,( ner% 1 am ete+a( tata+aana ner% et%a- em-at am ?-a*a -a%en ang a*ar/&ang,n@ -a%en ang mena+an% -roe*,r mena%tan e&e+,m tran;er -a%en *an e&e+,m  -a%en -,+ang *ar% r,ma( a%t.

3. Pa*a -a%en ang menga+am% ner% ar*%a ?ant,ng@ +a,an aemen ,+ang et%a- 5 men%t ete+a( -em&er%an n%trat ata, o&ato&at %ntra<ena.

4. Pa*a ner% a,t/ron% +a,an aemen ,+ang t%a- 30 men%t C 1 am ete+a(  -em&er%an o&at ner%.

5. Deraat ner% ang men%ngat (e&at e7ara t%&at%&a ter,tama &%+a am-a% men%m&,+an -er,&a(an tan*a <%ta+ mer,-aan tan*a a*ana *%agno% me*% ata, &e*a( ang &ar, ?m%a+na om-+%a% -a7a-em&e*a(an ner% ne,ro-at%@

IV. MANAJEMEN NYEI A. Manaemen Ner% A,t

1. Ner% a,t mer,-aan ner% ang tera*% H  m%ngg,.

2. Me+a,an aemen ner% : anamne% -emer%aan ;%% -emer%aan  -en,nang *an aemen ner% mengg,naan a+a ner%.

3. Menent,an mean%me ner% : a. Ner% omat% :

 D%a%&atan a*ana er,aan ar%ngan ang mene&a&an -e+e-aan

Bat %ma *ar% e+ ang 7e*era *an meme*%a% %n;+ama% *an ner% me+a+,% no%e-tor ,+%t.

 !arater%t% : onet 7e-at ter+oa+%a% *engan &a% *an ner% &er%;at

taam men,, ata, e-ert% *%t%am.

 >onto( : ner% a%&at +aera% sprain ;rat,r *%+oa%.

 &. Ner% <%7era+ :

 No%e-tor <%7era+ +e&%( et%%t *%&an*%ngan omat%7 e(%ngga %a

tert%m,+a% aan men%m&,+an ner% ang ,rang &%a *%+oa+%a%  &er%;at *%;, t,m-,+ e-ert% *%tean &en*a &erat.

 Pene&a& : %em%/nero% %n;+ama% -eregangan +%gament -ame

otot -o+o *%ten% organ &erongga/+,men.

 '%aana *%erta% *engan gea+a otonom e-ert% m,a+ m,nta(

(%-oten% &ra*%ar*%a &erer%ngat. 7. Ner% ne,ro-at% :

 'eraa+ *ar% 7e*era ar%ngan ara;.

 S%;at ner%: raa ter&aar ner% mena+ar eem,tan a+o*%n%a ?ner%

aat *%ent,(@ (%-era+ge%a.

 $ea+a ner% &%aana *%a+am% -a*a &ag%an *%ta+ *ar% tem-at 7e*era

?ementara -a*a ner% no%e-t%; ner% *%a+am% -a*a tem-at 7e*erana@.

 '%aana *%*er%ta o+e( -a%en *engan *%a&ete multiple sclerosis

(ern%a% *%, AIDS -a%en ang mena+an% emotera-%/ra*%otera-%.

4. Tata+aana e,a% mean%me ner%na.

a. 8armao+og% : g,naan Step-adder #*

 #AINS e;et%; ,nt, ner% r%ngane*ang o-%o%* e;et%; ,nt, ner%

e*ang C &erat.

 M,+a%+a( *engan -em&er%an #AINS/o-%o%* +ema( ?+anga( 1 *an 2@

*engan -em&er%an %nterm%ten ? pro re nata  C -rn@ o-%o%* ,at ang *%e,a%an *engan e&,t,(an -a%en.

 J%a +anga( 1 *an 2 ,rang e;et%;/ner% mena*% e*ang C &erat *a-at

*%t%ngatan mena*% +anga( 3 ?gant% *engan o-%o%* ,at *an -rn ana+ge% *a+am ,r,n )at, 24 am ete+a( +anga( 1@.

 Pengg,naan o-%o%* (ar, *%t%tra%. #-%o%* tan*ar ang er%ng

*%g,naan a*a+a( Mor;%n >o*e%n.

 J%a -a%en mem%+%% ontra%n*%a% a&o+,t #AINS *a-at *%&er%an

o-%o%* r%ngan.

 J%a ;ae ner% a,t -a%en te+a( ter+e)at% +a,an -eng,rangan *o%

e7ara &erta(a- :

 Intra<ena : ant%on<,+an !etam%ne #AINS #-%o%*.



#ra+ : ant%on<,+an ant%*e-rean ant%(%tam%n an%o+t%7 !ort%otero%* anete% +oa+ #AINS #-%o%* Trama*o+.

 eta+ ?,-o%tor%a@ : Paraetamo+ A-%r%n #-%o%* 8enot%aB%n.



To-%7a+ : =%*oa%n -at7( EM=A.



S,&,tan : #-%o%* anete% +o7a+.

&-Step #* Analgesic adder +

!eterangan :

  Patch 8entan+ t%*a &o+e( *%g,naan ,nt, ner% a,t arena t%*a 

e,a% %n*%a% *an onet erana +ama.

 Unt, ner% ron% : -ert%m&angan -em&er%an tera-% ana+ge% 

a*,<an ?m%a+na : Am%tr%-t%+%n $a&a-ent%n@.

It%+a( :

  NSAID : non-steroidal anti-inflammatory drug.  S/ : slo, release.

 PN : ,hen reuired .

 &. 'er%,t a*a+a( a+gor%tma -em&er%an #-%o%* %nterm%ten ?-rn@ %ntra<ena ,nt, ner% a,t *engan arat :

 "ana *%g,naan o+e( ta; ang te+a( men*a-at %ntr,%.

 T%*a e,a% ,nt, -em&er%an ana+ge% e7ara r,t%n *% r,ang ra)at

%na- &%aa.

 E;e -,n7a *ar% *o% %ntra<ena *a-at tera*% e+ama 15 men%t e(%ngga

em,a -a%en (ar, *%o&er<a% *engan etat e+ama ;ae %n%.

A+gor%tma Pem&er%an #-%o%* Interm%ten Intra<ena ,nt, Ner% A,t

3paka pasien nyeri seangerat 6 t%*a  7ser1asi r+8n ya _t%*a 

Saat osis tela ierikan, lak+kan 3paka iresepkan opioi i.1 6 inta +nt+k iresepkan monitor se8ap 5 menit sela ma

minimal 20 menit.

T+ngg+ ingga 0 menit ari G +nakan sp+it %0 ml pemerian osis terakir se5el+ m

ya 3mil %0 mg or:n s+l;at meng+langi sikl+s. _{ an /amp+r engan <a=l} $okter m+ngkin perl+ +nt+k _{0,9> ingga %0 ml (% mgml!}

meresepkan osis +langan

? erikan lael paa sp+it Siapkan <a=l ATAU

Ya, tetapi

G +nakan sp+it %0 ml tela

3mil %00 mg @e8in an ierikan

/a _{mp+r engan <a=l 0,9>}

7ser1asi r+8n

osis total _{ya ingga %0 ml (%0 mgml!} 8ak ? erikan lael paa sp+it

<yeri y a Skor seasi 0 ata+ %6 _{int a saran ke okter senior} T+na osis ingga skor seasi A

2 an ke/epatan pernapasan B &

T+ngg+ selama 5 menit ya 8ak Ke/epatan pernapasan B & kalimenit 6 ya

Tekanan ara sistolik C %00 mmDg 6 E

ya

Fsia pasien A 0 ta+n6

ya

kali menit.

@er8 mangkan <alokson # (%00 +g!

8ak

inta saran

8ak Jika skor nyeri )%0* erikan 2ml

J

ika skor nyeri 4)"* erikan % ml

Jika skor nyeri )%0* erikan ml Jika skor nyeri 4)"* erikan 2 ml

Sor e*a% : 0  a*ar -en,(

1  e*a% r%ngan a*ang mengant, m,*a( *%&ang,nan

2  e*a% e*ang er%ng e7ara ontan mengant, m,*a( *%&ang,nan

3  e*a% &erat omno+en ,ar  *%&ang,nan

S  t%*,r norma+

$,naan ta&e+ o&ato&atan ant%emet%7 ?%a *%-er+,an@.

Ter,an -engg,naan #AINS %.< %a *%ree-an &erama *engan o-%o%*.

7. Manaemen e;e am-%ng :

 #-%o%*

- M,a+ *an m,nta( : ant%emet%7

- !ont%-a% : &er%an t%m,+an &,ang a%r &ear (%n*ar% +aat%; ang

mengan*,ng erat arena *a-at mene&a&an -ro*,% ga em&,ngram -er,t.

J%a teanan *ara( %to+% H 100 mm"g : (ar,+a( *a+am rentang 30G teanan *ara( %to+% norma+ -a%en ?%a *%eta(,%@ ata, 7ar%+a( aran/&ant,an. >atatan : !eterangan : Sor ner% : 0  t%*a ner% 1 C 3  ner% r%ngan 4 C   ner% e*ang 9 C 10  ner% &erat

- $ata+ : -ert%m&angan ,nt, menggant% o-%o%* en% +a%n *a-at ,ga

mengg,naan ant%(%tam%n.

- M%o+on, : -ert%m&angan ,nt, menggant% o-%o%* ata, &er%an 'enBo*%aBe-%ne ,nt, mengata% m%o+on,.

- De-re% -erna-aan a%&at #-%o%* : &er%an Na+oon ?7am-,r 04 mg Na+oon *engan Na>+ 0G e(%ngga tota+ <o+,me men7a-a% 10 m+@. 'er%an 002 mg ?05 m+@ &o+, et%a- men%t (%ngga e7e-atan -erna-aan men%ngat. Da-at *%,+ang %a -a%en men*a-at tera-% #-%o%* anga -anang.

 #AINS :

- $angg,an gatro%ntet%na+ : &er%an PPI (proton pump inhibitor).

- Per*ara(an a%&at *%;,ng% -+ate+et : -ert%m&angan ,nt, 

menggant% #AINS ang t%*a mem%+%% e;e ter(a*a- agrega%  -+ate+et.

*. Pem&e*a(an : %ne% e-%*,ra+ ,-ra-%na+ %n;%+tra% anete% +oa+ *% tem-at ner%. e. Non;armao+og% :  #+a( raga  Imo&%+%a%  P%at  e+aa%

 St%m,+a% ara; tran,tan e+etr% 



5. 8o++o),-/Aemen U+ang

a. Aemen ,+ang e&a%na *%+a,an *engan %nter<a+ ang terat,r.  &. Pan*,an ,m,m :

 Pem&er%an -arentera+ : 30 men%t  Pem&er%an ora+ : 0 men%t

 Inter<en% non;armao+og% : 30 C 0 men%t.

. Pen7ega(an

a. E*,a% -a%en :

 'er%an %n;orma% mengena% on*%% *an -ena%t -a%en erta

tata+aanana.

 D%,%an t,,an *ar% manaemen ner% *an man;aatna ,nt, -a%en.  'er%ta(,an &a()a -a%en *a-at meng,&,ng% t%m me*% %a mem%+%%

 -ertanaan/%ng%n &eron,+ta% mengena% on*%%na.

 Pa%en *an e+,arga %,t *%+%&atan *a+am men,,n manaemen ner%

?terma, -ena*)a+an me*%a% -em%+%(an ana+ge% *an a*)a+ ontro+@.

 &. !e-at,(an -a%en *a+am mena+an% manaemen ner% *engan &a%.

9. Me*%a% aat -a%en -,+ang

a. Pa%en *%-,+angan egera ete+a( ner% *a-at terata% *an *a-at  &erat%<%ta e-ert% &%aa/norma+.

 &. Pem%+%(an me*%a% ana+ge% &ergant,ng -a*a on*%% -a%en. . 'er%,t a*a+a( a+gor%tma aemen *an manaemen ner% a,t :

A+gor%tma Aemen Ner% A,t

@asien mengel+ nyeri

3namnesis an pemeriksaan :sik

3sesmen nyeri

ya

3paka e8ologi nyeri @rioritas +tama* ien8:kasi

5ersi;at re1ersi5le 6 _{an atasi e8ologi nyeri}

8ak

ya Hiat manaemen nyeri 3paka nyeri erlangs+ng B " kronik.

@er8mangkan +nt+k mingg+ 6

mer++k ke spesialis yang

8ak ses+ai

Tent+kan mekanisme nyeri (pasien

0apat mengalami B % enis nyeri!

Nyeri somatc Nyeri viseral Nyeri neuropatk <yeri ersi;at taam, men+s+k, <yeri ersi;at i;+s, seper8 <yeri ersi;at menalar, rasa

terlokalisir, seper8 i8kam itekan ena erat, nyeri terakar, kesem+tan, 8ak t+mp+l spesi:k.

A+gor%tma Manaemen Ner% A,t

Nyeri somatc

@arasetamol

Cold packs

Kor8kosteroi

3nestesi lokal (topi/al  in:ltrasi! 73#<S

7pioi

@ili alterna8; terapi yang lainnya

8ak

Nyeri viseral Nyeri neuropatk Kor8kosteroi 3n8kon1+lsan

3nestesi lokal intraspinal Kor8kosteroi 73#<S ?lokne+ron 7pioi 73#<S 7pioi 3n8epresan trisiklik Pencegahan Hiat manaemen ya

nyeri kronik. 3paka nyeri B @er8mangkan

+nt+k mer++k ke " mingg+ 6 spesialis yang

ses+ai

ya Kemali ke kotak ekanisme

Itent+kan 8ak nyeri ses+ai 6 mekanisme nyeri

+kasi pasien Terapi ;armakologi Kons+ltasi (ika perl+! @rose+r pemeaan <on);armakologi 8ak 3nalgesik aek+at 6 ya ya ;ek samping pengoatan 6 8ak 'olloL)+p  nilai +lang anaemen e;ek samping

'. Manaemen Ner% !ron% 

1. Ner% ron% : ner% ang -er%ten/&er+ang,ng   m%ngg,. 2. Me+a,an aemen ner% :

a. Anamne% -emer%aan ;%% ?arater%t% ner% r%)aat manaemen ner% e&e+,mna@ -emer%aan -en,nang *an aemen ner% *engan a+a ner%.

 &. Aemen ;,ng%ona+ :

 n%+a% at%<%ta (%*,- *aar ?AD=@ %*ent%;%a% e7a7atan/*%a&%+%ta.  &,at+a( t,,an ;,ng%ona+ -e%;% *an ren7ana -era)atan -a%en.  n%+a% e;et%;%ta ren7ana -era)atan *an manaemen -engo&atan.

3. Menent,an mean%me ner% :

a. Manaemen &ergant,ng -a*a en%/+a%;%a% ner%na.  &. Pa%en er%ng menga+am%  1 en% ner%.

7. Ter&ag% mena*% 4 en% : 1@ Ner% ne,ro-at% :

- D%e&a&an o+e( er,aan/*%;,ng% %tem omatoenor%. - >onto( : ne,ro-at% DM ne,ra+g%a tr%gem%na+ ne,ra+g%a -a7a

(er-et%.

- !arater%t% : ner% -er%ten raa ter&aar ter*a-at -ena+aran

ner% e,a% *engan -erara;anna &aa+ eem,tan a+o*%n%a.

- 8%&roma+g%a : gata+ a, *an ner% ang *%;, -a*a

m,7,+oe+eta+ ?&a(, etrem%ta@ ner% &er+ang,ng e+ama  3  &,+an.

2@ Ner% otot : terer%ng a*a+a( ner% m%o;a%a+

- Mengena% otot +e(er &a(, +engan -,ngg,ng &a)a( -angg,+ *an

etrem%ta &a)a(.

-  Ner% *%raaan a%&at *%;,ng% -a*a 1/+e&%( en% otot &era%&at

e+ema(an eter&ataan gera.

- '%aana m,n7,+ a%&at at%<%ta -eeraan ang re-et%t%<e.

- Tata+aana : mengem&a+%an ;,ng% otot *engan ;%%otera-%

%*ent%;%a% *an manaemen ;ator ang mem-er&erat ?-ot,r geraan re-et%t%<e ;ator -eeraan@.

3@ Ner% %n;+ama% ?*%ena+ ,ga *engan %t%+a( ner% no%e-t%;@ :

- >onto( : artr%t% %n;e% 7e*era ar%ngan ?+,a@ ner% -a7ao-era%.

- !arater%t% : -em&engaan emera(an -ana -a*a tem-at ner%.

Ter*a-at r%)aat 7e*era/+,a.

- Tata+aana : manaemen -roe %n;+ama% *engan

ant%&%ot%/ant%remat% #AINS ort%otero%*. 4@ Ner% mean%/om-re% :

- D%-er&erat *engan at%<%ta *an ner% &er,rang *engan %t%ra(at. - >onto( : ner% -,ngg,ng *an +e(er ?&era%tan *engan tra%n/-ra%n

+%gamen/otot@ *egenera% *%, oteo-oro% *engan ;rat,r  om-re% ;rat,r.

- Mer,-aan ner% no%e-t%;.

- Tata+aana : &e&era-a memer+,an *eom-re% ata, ta&%+%a%.

4. Aemen +a%nna

a. Aemen -%o+og% : n%+a% a-aa( -a%en mem-,na% maa+a( -%%atr% ?*e-re% 7ema r%)aat -ena+a(g,naan o&ato&atan r%)aat  -engan%aaan e7ara e,a+/;%% <er&a+ gangg,an t%*,r@.

 &. Maa+a( -eeraan *an *%a&%+%ta. 7. 8ator ang mem-engar,(% :



!e&%aaan aan -ot,r +e(er *an e-a+a ang &,r,.



Pena%t +a%n ang mem-er&,r,/mem%7, ner% ron% -a%en. *. "am&atan ter(a*a- tata+aana :

1@ "am&atan om,n%a%/&a(aa. 2@ 8ator ;%nan%a+.

3@ en*a(na mot%<a% *an ara ang a,( ter(a*a- ;a%+%ta ee(atan. 4@ !e-at,(an -a%en ang &,r,.

5@ !,rangna *,,ngan *ar% e+,arga *an teman. 5. Manaemen ner% ron% 

a. Pr%n%- =e<e+ 1 :

1@ ',at+a( ren7ana -era)atan tert,+% e7ara om-re(en%; ?&,at t,,an  -er&a%% t%*,r t%ngatan at%<%ta ;%% manaemen tre ,rang%

ner%@.

2@ Pa%en (ar, &er-art%%-a% *a+am -rogram +at%(an ,nt, men%ngatan ;,ng%.

3@ Doter *a-at mem-ert%m&angan -en*eatan -er%+a, ogn%t%; *engan retora% ;,ng% ,nt, mem&ant, meng,rang% ner% *an men%ngatan ;,ng%.

- 'er%ta(,an e-a*a -a%en &a()a ner% ron% a*a+a( maa+a( ang

r,m%t *an om-+e. Tata+aana er%ng men7a,- manaemen tre +at%(an ;%% tera-% re+aa% *an e&aga%na.

- 'er%ta(,an -a%en &a()a ;o, *oter a*a+a( manaemen

ner%na.

- Aa+a( -a%en ,nt, &er-art%%-a% at%; *a+am manaemen ner%. - 'er%an me*%a% ner% ang terat,r *an terontro+.

- Ja*)a+an 7ontro+ -a%en e7ara r,t%n angan &%aran -ena*)a+an

,nt, 7ontro+ *%-engar,(% o+e( -en%ngatan +e<e+ ner% -a%en.

- 'eeraama *engan e+,arga ,nt, mem&er%an *,,ngan e-a*a  -a%en.

- 'ant,+a( -a%en agar *a-at em&a+% &eera e7ara &erta(a-. - Ata% eengganan -a%en ,nt, &ergera arena ta,t ner%. 4@ Manaemen -%oo%a+ ?ata% *e-re% e7emaan eta,tan -a%en@.

 &. Manaemen =e<e+ 1 : mengg,naan -en*eatan tan*ar *a+am  -enata+aanaan ner% ron% terma, ;armao+og% %nter<en% non

;armao+og% *an tera-% -e+enga-/tam&a(an.

1@ Ner% Ne,ro-at% 

 Ata% -ene&a& ang men*aar% t%m&,+na ner% :

- !ontro+ g,+a *ara( -a*a -a%en DM.

- Pem&e*a(an emotera-% ra*%otera-% ,nt, -a%en t,mor

*engan om-re% ara;.

- !ontro+ %n;e% ?ant%&%ot%@.

 Tera-% %m-tomat% :

- ant%*e-rean tr%%+% ?Am%tr%-t%+%n@.

- ant%on<,+an : $a&a-ent%n !ar&amaBe-%n.

- o&at to-%7a+ ?=%*o7a%ne -at7( 5G r%m anete%@. - #AINS !ort%otero%* #-%o%*.

- anete% reg%ona+ : &+o %m-at% &+o e-%*,ra+/%ntratea+ %n;,

e-%*,ra+/%ntratea+.

- tera-% &er&a%t%m,+a% : a,-,nt,r t%m,+a% -%na+ -%at. - re(a&%+%ta% ;%% : &%*a% man%-,+a% a+at &ant, +at%(an

mo&%+%a% meto*e ergonom%.

-  -roe*,r a&+a% : or*om%otom% a&+a% ara; *engan

ra*%o;re,en%.

- tera-% +a%nna : (-no% tera-% re+aa% ?meng,rang% tegangan

otot *an to+eran% ter(a*a- ner%@ tera-% -er%+a, ogn%t%;  ?meng,rang% -eraaan teran7am ata, t%*a naman arena ner% ron%@.

2@ Ner% otot

 =a,an r%n%ng ter(a*a- -ato+og% me*% ang er%, ;ator

 -%oo%a+ ang *a-at meng(am&at -em,+%(an.

 'er%an -rogram +at%(an e7ara &erta(a- *%m,+a% *ar% +at%(an

*aar/a)a+ *an *%t%ngatan e7ara &erta(a-.

 e(a&%+%ta% ;%% :

- 8%tne : angat &e&an &erta(a- ar*%o<a,+ar ;+e%&%+%ta

ee%m&angan

- Mean% 

- P%at tera-% a,at% 

 Manaemen -er%+a, : - tre/*e-re% - ten% re+aa% -  -er%+a, ogn%t%;  - etergant,ngan o&at - manaemen amara(  Tera-% o&at :

- ana+ge% *an e*a% - ant%*e-rean

- o-%o%* arang *%&,t,(an

3@ Ner% %n;+ama%

 !ontro+ %n;+ama% *an ata% -ene&a&na.

 #&at ant%%n;+ama% ,tama : #AINS !ort%otero%*.

4@ Ner% mean%/om-re%

 Pene&a& ang er%ng : t,mor/%ta ang men%m&,+an om-re%

 -a*a tr,t,r ang en%t%; *engan ner% *%+oa% ;rat,r.

 Penanganan e;et%; : *eom-re% *engan -em&e*a(an ata,

ta&%+%a% &%*a% a+at &ant,.

 Me*%amentoa ,rang e;et%;. #-%o%* *a-at *%g,naan ,nt,

mengata% ner% aat tera-% +a%n *%a-+%a%an. 7. Manaemen =e<e+ 1 +a%nna :

%! #AINS *a-at *%g,naan ,nt, ner% r%ngan C e*ang ata, ner% non ne,ro-at%.

2! Sor DIE : *%g,naan ,nt, men%+a% ee,a%an a-+%a% tera-% #-%o%*  anga -anang ,nt, ner% ron% nonaner.

Sor DIE ? iagnosis/ Intractibility/ !isk/ 0fficacy@

Sor 8ator Pene+aan

D%agno% 1  on*%% ron% r%ngan *engan tem,an o&et%; m%n%ma+ ata, t%*a a*ana *%agno% me*% ang -at%. M%a+na : ;%&roma+g%a m%gra%ne ner% -,ngg,ng t%*a -e%;%.

2  on*%% -rogre%; -er+a(an *engan ner% e*ang ata, on*%% ner% e*ang meneta- *engan tem,an o&et%; me*%,m.

M%a+na : ner% -,ngg,ng *engan -er,&a(an *egenerat%<e me*%,m ner% ne,ro-at%.

3  on*%% +an,t *engan ner% &erat *an tem,an o&et%; nata. M%a+na : -ena%t %em% <a7,+ar &erat ne,ro-at% +an,t teno% -%na+ &erat.

 Intractability 1  -em&er%an tera-% m%n%ma+ *an -a%en ter+%&at e7ara m%n%ma+ ( eter+%&atan ) *a+am manaemen ner%.

2  &e&era-a tera-% te+a( *%+a,an teta-% -a%en t%*a  e-en,(na ter+%&at *a+am manaemen ner% ata, ter*a-at (am&atan ? ;%nan%a+ tran-orta% -ena%t me*% @. 3  -a%en ter+%&at e-en,(na *a+am manaemen ner% teta-%

re-on tera-% t%*a a*e,at. %%o ( ! )   ,m+a( or P K ! K  K D

P%o+og% 1  *%;,ng% e-r%&a*%an ang &erat ata, gangg,an %)a ang mem-engar,(% tera-%.

M%a+na : gangg,an e-r%&a*%an gangg,an a;e &erat. 2  gangg,an %)a / e-r%&a*%an me*%,m/e*ang.

M%a+na : *e-re% gangg,an 7ema.

3  om,n%a% &a%. T%*a a*a *%;,ng% e-r%&a*%an ata, gangg,an %)a ang %gn%;%an

!ee(atan 1  -engg,naan o&at a(%ra(%r %n% a+o(o+ &er+e&%(an  -ena+a(g,naan o&at.

2  me*%a% ,nt, mengata% tre ata, r%)aat rem%%  -%o;armaa.

3  t%*a a*a r%)aat -engg,naan o&ato&atan.

e+%a&%+%ta 1  &ana maa+a( : -ena+a(g,naan o&at &o+o era/a*)a+ ontro+ om-+%an &,r,.

2  tera*ang menga+am% e,+%tan *a+am om-+%an teta-% e7ara ee+,r,(an *a-at *%an*a+an.

3  angat *a-at *%an*a+an ?me*%a% a*)a+ ontro+ *an tera-%@ D,,ngan 1  (%*,- a7a, *,,ngan e+,arga m%n%ma+ e*%%t teman

o%a+ *eat e(%+angan -eran *a+am e(%*,-an norma+.

2  ,rangna (,&,ngan *engan ora+ *an ,rang &er-eran *a+am o%a+. 3  e+,arga men*,,ng (,&,ngan *eat. Ter+%&at *a+am

era/eo+a( t%*a a*a %o+a% o%a+.

E;%a% 1  ;,ng% &,r, ata, -eng,rangan ner% m%n%ma+ me% *engan  -engg,naan *o% o&at e*angt%ngg%.

2  ;,ng% men%ngat teta-% ,rang e;%%en ?t%*a mengg,naan o-%o%* *o% e*angt%ngg% @.

3  -er&a%an ner% %gn%;%an ;,ng% *an ,a+%ta (%*,- ter7a-a% *engan *o% ang ta&%+.

Sor tota+  D K I K  K E

!eterangan :

Sor 9 C 13 : t%*a e,a% ,nt, mena+an% tera-% o-%o%* anga -anang Sor 14 C 21 : e,a% ,nt, mena+an% tera-% o-%o%* anga -anang

3@ Inter<en% : %ne% -%na+ &+o ara; t%m,+ator -%na+ %n;, %ntratea+ %ne% %ntraen*% %ne% e-%*,ra+.

4@ Tera-% -e+enga- / tam&a(an : a,-,nt,r (er&a+. *. Manaemen =e<e+ 2

1@ Me+%-,t% r,,an e t%m m,+t%*%%-+%n *a+am manaemen ner% *an re(a&%+%ta%na ata, -em&e*a(an ?e&aga% gant% t%m,+ator -%na+ ata, %n;, %ntratea+@.

2@ In*%a% : -a%en ner% ron% ang gaga+ tera-% oner<at%;/manaemen +e<e+ 1.

! '%aana r,,an *%+a,an ete+a( 4 C  m%ngg, t%*a a*a -er&a%an *engan manaemen +e<e+ 1.

'er%,t a*a+a( a+gor%tma aemen *an manaemen ner% ron% : A+gor%tma Aemen Ner% !ron% 

@asien mengel+ nyeri

Asesmen nyeri 3namnesis

@emeriksaan :sik @emeriksaan ;+ngsi

Tent+kan mekanisme nyeri

@asien apat mengalami enis nyeri an ;aktor yang

mempengar+i yang eragam

Nyeri neuropatk @eri;er (sinrom nyeri

regional kompleks, ne+ropa8 D#, gangg+an metaolik! Sentral (@arkinson,multple sclerosis, mielopa8, nyeri pas/a)stroke, sinrom :romyalgia!

Nyeri oo Nyeri infamasi <yeri mio;asial 3rtropa8 inMamasi

(rematoi artri8s! #n;eksi

<yeri pas/a)oparasi =eera aringan

3paka nyeri kronik6 80ak

ya

3paka e8ologinya apat ikoreksi  iatasi6

ya

8ak

Asesmen lainnya asala pekeraan an isailitas 3sesmen psikologi an spirit+al

'aktor yang mempengar+i an amatan

Nyeri mekanis/kompresi <yeri p+ngg+ng aLa <yeri leer <yeri m+s/+loskeletal (a+, sik+! <yeri 1iseral

@anta+ an oser1asi

3tasi e8ologi nyeri ses+ai inikasi

pasien

Asesmen hasil

RS PKU M/amma0i"a/ Y!"a#a$ta nit II

Layanan primer unuk mengukur pencapaian ujuan dan meninjau ulang

rencana perawaan anajemen level ! lainnya

A+gor%tma Manaemen Ner% !ron% 

Prinsip level !

?+atla ren/ana an tetapkan t++an Neailitasi :sik engan t++an ;+ngsional

anaemen psikososial engan t++an ;+ngsional

anajemen level !" anajemen level !" anajemen level !" anajemen level !" Nyeri Nyeri neuropatk Nyeri oo Nyeri infamasi mekanis/kompresi

'armakologi (skor $#N! #nter1ensi

@elengkap  tamaan

T++an terpen+i6 8ak Tela melak+kan ya anajemen level # '+ngsi manaemen le1el % N++k ke 8m interisiplin, Kenyamanan engan aek+at6

amatan ata+

N++k ke klinik k+s+s ya manaemennyeri $encana perawaan selanjunya oleh 8ak

>. Manaemen Ner% Pa*a Pe*%atr% 

1. Pre<a+en% ner% ang er%ng *%a+am% o+e( ana a*a+a( : a%t e-a+a ron% tra,ma a%t -er,t *an ;ator -%o+og%.

2. S%tem no%e-t%; -a*a ana *a-at mem&er%an re-on ang &er&e*a ter(a*a-er,aan ar%ngan ang ama ata, e*eraat.

3. Neonat, +e&%( en%t%; ter(a*a- t%m,+, ner%.

4. 'er%,t a*a+a( a+gor%tma manaemen ner% men*aar -a*a -e*%atr% :

A+gor%tma Manaemen Ner% Men*aar Pa*a Pe*%atr%  1. Aemen ner% -a*a ana 

<ilai karakteris8k nyeri

Hak+kan pemeriksaan meis an pen+nang yang ses+ai

1al+asi kem+ngkinan aanya keterliatan mekanisme nosisep8; an ne+ropa8k

Kaila ;aktor yang mempengar+i nyeri paa anak

2. D%agno% -ene&a& -r%mer *an e,n*er 

Komponen nosisep8; an ne+ropa8k yang aa saat ini K+mp+lkan geala)geala :sik yang aa

@ikirkan ;aktor emosional, kogni8;, an perilak+

3. P%+%( tera-% ang e,a%

%&a Non'o&a

3nalgesik Kogni8;  

3nalgesik a+1ant 'isik

anestesi perilak+

4. Im-+ementa% ren7ana manaemen ner%

?erikan +mpan alik mengenai penyea an ;aktor yang mempengar+i nyeri kepaa orang t+a (an anak!

?erikan ren/ana manaemen yang rasional an terintegrasi 3sesmen +lang nyeri paa anak se/ara r+8n

1al+asi e;ek8:tas ren/ana manaemen nyeri Ne1isi ren/ana ika iperl+kan

5. Pem&er%an ana+ge% :

a. L $y the ladder  : -em&er%an ana+ge% e7ara &erta(a- e,a% *engan +e<e+ ner% ana ?r%ngan e*ang &erat@.

 A)a+na &er%an ana+ge% r%ngan C e*ang ?+e<e+ 1@.

 J%a ner% meneta- *engan -em&er%an ana+ge% +e<e+ 1 na%+a( e +e<e+

2 ?-em&er%an ana+ge% ang +e&%( -oten@.

 Pa*a -a%en ang men*a-at tera-% o-%o%* -em&er%an -araetamo+

teta-*%a-+%a%an e&aga% ana+ge% a*,<ant.

 Ana+ge% a*,<ant :

Mer,-aan o&at ang mem%+%% %n*%a% -r%mer &,an ,nt, ner% teta-% *a-at &ere;e ana+ge% *a+am on*%% tertent,.

Pa*a ana *engan ner% ne,ro-at% *a-at *%&er%an ana+ge% a*,<ant e&aga% +e<e+ 1.

Ana+ge% a*,<ant %n% +e&%( -e%;% *an e;et%; ,nt, mengata% ner% ne,ro-at%.

!ategor% :

- Ana+ge% m,+t%t,,an : ant%*e-rean agon% a*renerg%7 a+;a2

!ort%otero%* anete% to-%7a+.

- Ana+ge% ,nt, ner% ne,ro-at% : ant%*e-rean ant%on<,+an

agon% $A'A anete% ora++oa+.

- Ana+ge% ,nt, ner% m,7,+oe+eta+ : re+aan otot

'enBo*%aBe-%ne %n(%&%tor oteo+a ra*%o;armaa.

. L $y the clock  : menga7, -a*a )at, -em&er%an ana+ge%.

Pem&er%an (ar,+a( terat,r m%a+na : et%a- 4 C  am ?*%e,a%an *engan maa era o&at *an *eraat e-ara(an ner% -a%en@ t%*a &o+e( -rn ?%a  -er+,@ e7,a+% e-%o*e ner% -a%en &enar&enar %nterm%ten *an t%*a *a-at

*%-re*%%.

/. L $y the child  : menga7, -a*a -eem&er%an ana+ge% ang e,a% *engan on*%% ma%ngma%ng %n*%<%*,.

 =a,an mon%tor *an aemen ner% e7ara terat,r.  Se,a%an *o% ana+ge% %a -er+,.

. L $y the mouth : menga7, -a*a a+,r -em&er%an ora+.

 #&at (ar, *%&er%an me+a+,% a+,r ang -a+%ng e*er(ana t%*a

%n<a%<e *an e;et%; &%aana -er ora+.

 !arena -a%en ta,t *engan ar,m ,nt% -a%en *a-at menanga+

 &a()a merea menga+am% ner% ata, t%*a memer+,an -engo&atan.

 Unt, men*a-atan e;e ana+ge% ang 7e-at *an +ang,ng -em&er%an

 -arentera+ tera*ang mer,-aan a+,r ang -a+%ng e;%%en.

 #-%o%* ,rang -oten %a *%&er%an -er ora+.

 Se&%a m,ng%n angan mem&er%an o&at <%a %ntram,7,+ar arena

ner% *an a&or&% o&at t%*a *a-at *%an*a+an.

 In;, ont%n, mem%+%% e,nt,ngan ang +e&%( *%&an*%ngan %.m %.<

*an ,&,tan %nterm%ten a%t, : t%*a ner% men7ega( tera*%na  -en,n*aan/eter+am&atan -em&er%an o&at mem&er%an 7ontro+ ner%

ang ont%n, -a*a ana.

 In*%a% : -a%en ner% *% mana -em&er%an -er ora+ *an o-%o%* -arentera+

%nterm%ten t%*a mem&er%an (a%+ ang mem,aan a*ana m,nta( (e&at ?t%*a *a-at mem&er%an o&at -er ora+@.

e. Ana+ge% *an anete% reg%ona+ : e-%*,ra+ ata, -%na+

 Sangat &erg,na ,nt, ana *engan ner% aner ta*%,m +an,t ang

,+%t *%ata% *engan tera-% oner<at%;.

 "ar, *%-anta, *engan &a%.

 'er%an e*,a% *an -e+at%(an e-a*a ta; etere*%aan egera o&at

o&atan *an -era+atan re,%ta% *an -en7atatan a,rat mengena% tan*a <%ta+/or ner%.

;. Manaemen ner% ron% 

'%aana mem%+%% -ene&a& m,+t%-e+ *a-at me+%&atan om-onen no%e-t%; *an ne,ro-at%.

 =a,an anamne% *an -emer%aan ;%% mene+,r,(.  Pemer%aan -en,nang ang e,a%.

 E<a+,a% ;ator ang mem-engar,(%.

 Program tera-% : om&%na% tera-% o&at *an nono&at ?ogn%t%; ;%% *an

 -er%+a,@.

 =a,an -en*eatan m,+t%*%%-+%n.

g. 'er%,t a*a+a( ta&e+ o&ato&atan nono-%o%* ang er%ng *%g,naan ,nt, ana :

#&ato&atan Nono-%o%*

#&at Do%   !eterangan

Paraetamo+ 10 C 15 mg/g'' ora+ E;e ant%%n;+ama% e7%+ e;e   et%a- 4 C  am gatro%ntet%na+ *an (emato+og% m%n%ma+ I&,-ro;en 5 C 10 mg/g'' ora+ E;e ant%%n;+ama%. "at%(at% -a*a

et%a-  C  am -a%en *engan gangg,an (e-ar/rena+ r%)aat -er*ara(an gatro%ntet%na+ ata, (%-erten%.

 Na-roen 10 C 20 mg/g''/(ar% E;e ant%%n;+ama%. "at%(at% -a*a ora+ ter&ag% *a+am 2 -a%en *engan *%;,ng% rena+. Do%

*o% ma%ma+ 1 g/(ar%.

D%+o;ena 1 mg/g'' ora+ E;e ant%%n;+ama%. E;e am-%ng ama et%a-  C 12 am *engan %&,-ro;en *an na-roen. Do%

ma%ma+ 50 mg/a+%.

(. Pan*,an -engg,naan #-%o%* -a*a ana :

 P%+%( r,te ang -a+%ng e,a%. Unt, -em&er%an anga -anang -%+%(+a(

 a+,r ora+.

 Pa*a -engg,naan %n;, ont%n, %.< e*%aan o&at #-%o%* era %ngat

*engan *o% 50G C 200G *ar% *o% %n;, -er am ont%n, -rn.

 J%a *%-er+,an   a+% o-%o%* era %ngat -rn *a+am 24 am na%an

*o% %n;, %.< -eram ont%n, e,m+a( : tota+ *o% #-%o%*

 -rn ang *%&er%an *a+am 24 am *%&ag% 24. A+ternat%; +a%nna a*a+a( *engan mena%an e7e-atan %n;, e&ear 50G.

 P%+%( #-%o%* ang e,a% *an *o%na.

 J%a e;e ana+ge% t%*a a*e,at *an t%*a a*a to%%ta  t%ngatan

*o% e&ear 50G.

 Saat tapering-off  ata, -eng(ent%an o&at : -a*a em,a -a%en ang

mener%ma o-%o%*  1 m%ngg, (ar, *%+a,an tapering-off ( ,nt,  meng(%n*ar% gea+a ,ithdra,al). !,rang% *o% 50G e+ama 2 (ar% +a+, ,rang% e&ear 25G et%a- 2 (ar%. J%a *o% e,%<a+en *engan *o% mor;%n ora+ ?0 mg/g''/(ar%@ o-%o%* *a-at *%(ent%an.

 Me-er%*%n t%*a &o+e( *%g,naan ,nt, anga +ama arena *a-at

tera,m,+a% *an men%m&,+an m%o+on, (%-erre;+e *an eang. %. Tera-% a+ternat%;/tam&a(an :

 !one+%ng

 Man%-,+a% chiropractic  "er&a+

. Tera-% nono&at

a. Tera-% ogn%t%; : mer,-aan tera-% ang -a+%ng &erman;aat *an mem%+%% e;e ang &ear *a+am manaemen ner% nono&at ,nt, ana 

 &. D%tra% ter(a*a- ner% *engan menga+%(an aten% e (a+ +a%n e-ert% m,% 7a(aa )arna ma%nan -ermen om-,ter -erma%nan ;%+m *an e&aga%na.

7. Tera-% -er%+a, &ert,,an ,nt, meng,rang% -er%+a, ang *a-at men%ngatan ner% *an men%ngatan -er%+a, ang *a-at men,r,nan ner%.

*. Tera-% re+aa% : *a-at &er,-a menge-a+an *an mengen*,ran ar% tangan menggeraan a% e,a% %rama menar% na-a *a+am.