askep perioperatif debridement

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RESUME KEPERAWATAN PERIOPERATIF

PADA Ny. P DENGAN DM TIPE 2 DENGAN ULKUS

DI IBS RSUD

DI IBS RSUD Dr. SOEHADI PRIJONEGORO SRAGEN

Dr. SOEHADI PRIJONEGORO SRAGEN

Pembi

Pembimbingmbing   !. !. A"A"#$emi" #$emi" %%eneni i T&T&'& '& R()imR()im#)* #)* S.K+.S.K+.* * M.Ke,.M.Ke,. 2

2. . K-K-inini"i"   DD#-#-imiminin* * SS..KeKe+.+.* * N,N,.* .* M.M.KeKe,.,.

Di,&,&n O-e)  Di,&,&n O-e)  !.

!. AngAnggie gie %%&&-i#n-i#n'i 'i M. M. P2P222/22//!/!! ! !02!02 2

2.. AAyy&&nn$$# # PPrrii''# # MM&&''ii##rr## P2P22222////!!! ! !!0011 1

1.. BB##yy& & ##))yy( O( O""''##33ii##nn PP222222////!!! ! !!0044 4

4.. BB&&$$i i SS##rri i DDee55ii PP222222////!!! ! !!0000

KEMENTRIAN KESEHATAN REPUBLIK INDONESIA

POLITEKN

POLITEKNIK

IK KESEHAT

KESEHATAN SURA

AN SURAKART

KARTA

A

JURUSAN KEPERAWATAN

2/!6

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RESUME KEPERAWATAN PERIOPERATIF PADA Ny. P DENGAN DM TIPE 2 DENGAN ULKUS DI IBS RSUD Dr. SOEHADI PRIJONEGORO SRAGEN

A. Pre O+er#'i3

I. Peng"#7i#n* $i-#"&"#n +#$# '#ngg#- ! M#re' 2/!6 +&"&- !/.!/ WIB. !. I$en'i'#, P#,ien

N#m#  Ny. P

Um&r  / '#)&n Jeni, "e-#min  Perem+&#n S'#'&,  K#5in Ag#m#  I,-#m A-#m#'  Sr#gen Pen$i$i"#n  SD Pe"er7##n  IRT N(.regi,'er  1462!0

Di#gn(,# me$i, +re (+er#,i  DM Ti+e 2 $eng#n U-"&, Jeni, 'in$#"#n (+er#,i  Debri$emen'

K#m#r (+er#,i  ! 2. I$en'i'#, Pen#ngg&ng J#5#b

N#m#  Tn. W

Um&r  6 '#)&n Jeni, "e-#min  L#"i8-#"i A-#m#'  Sr#gen H&b&ng#n  S&#mi 1. Ri5#y#' Ke,e)#'#n

#. Ke-&)#n U'#m#

P#,ien meng#'#"#n b#)5# -&"# +#$# "#"iny# 'i$#" "&n7&ng ,emb&)* +#,ien ,#ng#' ber)#r#+ ,e'e-#) (+er#,i n#n'i -&"#ny# bi,# ,eger# ,emb&)* #g#r bi,# 9e+#' +&-#ng $#n bi,# ber#"'i3i'#, ,e+er'i $&-& "#-#.

b. Ri5#y#' Peny#"i' Se"#r#ng

P#,ien meng#'#"#n "#"i "iriny# 'er"en# #ir +#n#,* ,e'e-#) !/ )#ri men7#$i membeng"#"* "emer#)#n* 'er$#+#' -&b#ng $#n n#n#)* 7#ri 'e-&n7&" ,&$#) meng)i'#m* "em&$i#n (-e) "e-&#rg# +#,ien $i b#5# "e +&,"e,m#, $#n men$#+#' 'er#+i (b#' (r#- y#i'& G-&9(+#gi 1:! '#b-e'* $#n $i-#"&"#n +ember,i)"#n -&"#* n#m&n ,e)#ri "em&$i#n "#"iny# ,em#"in membeng"#"

"em&$i#n +#,ien $ib#5# "e RSUD $r. S(e)#$i Pri7(neg(r( Sr#gen. Di RSUD $i-#"&"#n +emeri",##n GDS $eng#n )#,i- 42/ mg;$- $#n men$#+#' 'er#+i in3&, RL 2/ '+m $ri+ ,()(bi(n ! #m+&-* in7.9e3('#:im !gr;!2 7#m* in7. R#ni'i$in 6/ mg;!2 7#m $#n (b#' (r#- G-&9(+#gi 1:! '#b-e'. Kem&$i#n +#,ien

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$i+in$#) "e b#ng,#- me-#'i $#n $i ren9#n#"#n $ebri$emen' +#$# '#ngg#- ! M#re' 2/!6* ,e'e-#) g-&"(,# $#r#) n(rm#-.

9. Ri5#y#' Peny#"i' D#)&-&

P#,ien meng#'#"#n b#)5# +#$# '#)&n 2/!1 be-i#& men7#-#ni (+er#,i )erni# $#n $i"e'#)&i men$eri'# DM "#ren# g&-#ny# ,e-#-& 'inggi* ,e-#in i'& +#,ien 7&g# +ern#) $ir#5#' "#ren# "e-en7#r ge'#) bening. P#,ien 7&g# +ern#) $i

r#5#' $i RSJD S&r#"#r'# "#ren# meng#-#mi $emen,i#. $. Ri5#y#' Peny#"i' Ke-&#rg#

P#,ien meng#'#"#n 'i$#" #$# #ngg('# "e-&#rg# y#ng meng#-#mi +eny#"i' ,e+er'i y#ng $i $eri'# (-e) +#,ien.

4. P(-# 3&ng,i(n#-#. P(-# N&'ri,i

Sebe-&m ,#"i'  +#,ien meng#'#"#n m#"#n 281 "#-i $#-#m ,e)#ri $eng#n n#,i $#n -#&" +#&" ,er'# ,#y&r $#n min&m 08< ge-#, +er)#ri b#i" 'e) m#ni, m#&+&n #ir +&'i).

Se-#m# ,#"i'  +#,ien meng#'#"#n m#"#n ,e,&#i $eng#n $ie' y#ng $i beri"#n $#ri RS* +#,ien m&$#) )#&, $#n -#+#r* BB 46 "g* TB  !02 9m* $ie' !// ""#-.

b. P(-# E-imin#,i

Sebe-&m ,#"i'  +#,ien meng#'#"#n 'i$#" #$# g#ngg&#n $#-#m BAB m#&+&n BAK. P#,ien BAB !: +er)#ri* BAK 08 : +er)#ri.

Se-#m# ,#"i'  ,e-#m# m#,&" r&m#) ,#"i' +#,ien $i+#,#ng ,e-#ng "en9ing =D> 5#rn# &rin "&ning "e9("-#'#n* b#& ")#,* +r($&",i &rin 6//99. BAB $i b#n'& (-e) ,&#miny# mengg&n#"#n +i,+('

9. P(-# A"'i?i'#,;I,'ir#)#'

Sebe-&m ,#"i'  +#,ien meng#'#"#n 'i$&rny# 'i$#" #$# g#ngg&#n* +#,ien bi#,#ny# 08< 7#m $#n "#$#ng 'i$&r ,i#ng ! 7#m.

Se-#m# ,#"i'  +#,ien meng#'#"#n ,ering 'erg#ngg& 'i$&rny# "#ren# mer#,#"#n nyeri +#$# "#"iny# $#n 'er-#-& b#ny#" (r#ng y#ng -#-& -#-#ng be,&" ,e)ingg# "#m#r ,ering r#m#i $#n mengg#ngg& ,##' ingin 'i$&r.

6. Pemeri",##n #. Ke#$##n Um&m Ke,#$#r#n  9(m+(, men'i, ?i'#- ,ign  TD  !!/;</ mmHg RR  2/ :;meni' N  << :;meni' S  10*6 /_

b. Pemeri",##n Fi,i" =He#$ '( '(e>  !> Ke+#-#

Ben'&" me,(9)e+#-* ben7(-#n 'i$#" #$#. 2> R#mb&'

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1> M#'#

K(n7&n9'i?# 'i$#" #nemi,. 4> Te-ing#

Ber,i)* ,er&men 'i$#" #$#. 6> Hi$&ng

Hi$&ng ber,i). 0> Gigi $#n m&-&'

M&"(,# bibir "ering* gigi #g#" "('(r. > Le)er

Ti$#" #$# +embe,#r#n "e-en7#r 'yr(i$ $#n "e-en7#r ge'#) bening. <> D#$#

Din$ing $#$# ,ime'ri,* 'i$#" #$# +ening"#'#n +engg&n##n ('(' b#n'& +ern#3#,#n

@> P#r&

S&#r# +#r& br(n"(?e,i"&-er* ,(n(r $i,e-&r&) -#+#ng +#r&. !/> J#n'&ng

(r reg&-er* g#--(+ $#n m&rm&r 'i$#" #$#. !!> Ab$(men

Din$ing +er&' $#'#r* ,&+e-* 'ym+#ni* bi,ing &,&, 6:;meni' !2> P&ngg&ng

Ti$#" #$# -&"# $e"&bi'&,. !1> Geni'#-i#

Ber,i).

!4> Angg('# ger#" #'#,

Ti$#" #$# 9e$er#* "e$&# '#ng#n m#m+& $iger#""#n !6> Angg('# ger#" b#5#)

K#n#n n(rm#-. Kiri #$# &-"&, $m gr#$e 1* -&"# #$# 1 -("#,i ='e-#+#" "#"i  09m : 2*6 9m : ! 9m "#"i ,ebe-#) $#-#m 2*69m : 29m : /*69m $igi'i 2 -&"# ne"r(,i, ,#m+#i '&-#ng* #$# -&"# $#ri b#gi#n +r(",im#- $igi'i 2 ,#m+#i +&ngg&ng "#"i 19m : 2*69m>.

!0> T&rg(r "&-i'

B#i" ,e,&#i 3i,i(-(gi,. 0. Per,i#+#n Pen&n7#ng

#. L#b(r#'(ri&m*

T#ngg#- /68/182/!6

P#r#me'er H#,i- Ni-#i N(rm#-D#r#) r&'in Hem(g-(bin Eri'r(,i' Hem#'("ri' In$e" eri'r(,i' M MH MH Le&"(,i' Tr(mb(,i' RDW8W !!*4 4*!/ 16*/ <6*1 2*< 12*0 22*1/ 6/1 !1*! !2*28!<*! g;$-4*/480*!1 7';&-1*861* C </8@ 3-281!*2 +g 1!*<816*4 g;$-4*08 !!*6 !6/846/ rib&;&-!!*68!4*6 C

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MP Hi'&ng 7eni, Ne&'r(3i-MD Lim3(,i' G(- $#r#) Kimi# "-ini" G-&"(,# D#r#) Se5#"'& F&ng,i )#'i SGOT SGPT Gin7#-Ure&m "re#'inin *0 @*6 !/*6 @*< B 42 1 20 !4*1 /*0@ /8@@*@ 3-18</ C 48!< C !@84< C 2// mg;$-1! 12 &;-!/86/ /*0/8/*@/ mg;$-P#n'#&#n G&-# D#r#) Pre O+er#,i

T#ngg#- P#r#me'er H#,i- Ni-#i n(rm#-!!8/18!6 !08/18!6 !8/18!6 GDS GDS GDS GDP !!2 !<@ 2/0 !<@ 2// 68!!6 mg;$-. Per,i#+#n P#,ien #. Per,i#+#n 3i,i"

e" i$en'i'#,* me-e+#, +er)i#,#n* -#'i)#n n#3#, $#-#m* -#'i)#n b#'&" e3e"'i3 $#n ROM.

b. Per,i#+#n 3i,i(-(gi, !> P&#,#

Ter#")ir m#"#n "em#rin m#-#m* ,e"#r#ng ,&$#) +&#,# $#ri 7#m /2.//. P#,ien meng#'#"#n 'i$#" #$# #-ergi (b#'.

2> Per,i#+#n ,#-&r#n +en9ern##n $#n +er"emi)#n

S&$#) $i-#"&"#n -#?emen' $#n ,&$#) $i-#"&"#n +em#,#g#n D. 1> Per,i#+#n K&-i'

Are# y#ng #"#n $i(+er#,i ,&$#) $i9&"&r;,"ern. 9. Per,i#+#n +,i"(-(gi,

P#,ien meng#'#"#n '#"&' $i-#"&"#n (+er#,i* "#ren# be-&m +ern#) men7#-#ni (+er#,i. P#,ien meng#'#"#n ,&$#) $i7e-#,"#n (-e) $("'er b#)5# 'in$#"#n (+er#,i &n'&" member,i)"#n -&"# $i "#"i. P#,ien ber'#ny# mengen#i 5#"'& (+er#,i* #+#"#) ,e'e-#) (+er#,i -&"#ny# bi,# ,emb&) $#n "e-&#rg# ber'#ny# ,e'e-#) (+er#,i )#r&, m(n$(" ber#+# )#ri -#gi. E",+re,i 5#7#) +#,ien 'eg#ng $#n bing&ng.

$. In3(rme$ (n9en' S&$#) #$#.

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e. #ir#n +#ren'er#-. In3&, RL 2/ '+m. 3. B#7& (+er#,i.

B#7& $#n '(+i (+er#,i ,&$#) $i+#"#i"#n. g. Ob#' +reme$i"#,i

On$#n9en'r(n 4 mg $#n Mi$#(-#m 6 mg. ). Per,i#+#n #n#e,'e,i.

P#,ien $i-#"&"#n #n#e,'e,i regi(n#-;,+in#-* #'#, re"(men$#,i $#ri $("'er ,+e,i#-i, #n#e,'e,i. P#,ien $eng#n ASA 2.

<. F#"'(r Re,i"( Ter)#$#+ Pembe$#)#n #. U,i#

P#,ien $eng#n &,i# -#n7&' y#i'& / '#)&n* ,e)ingg# mem+&ny#i re,i"( -ebi) be,#r 'er)#$#+ +embe$#)#n.

b. N&'ri,i

Ti$#" #$# "(n$i,i m#-n&'ri,i* 'i$#" #$# (be,i'#,. 9. Peny#"i' Kr(ni,

P#,ien $eng#n $i#be'e, me--i'&, =$#-#m "(n$i,i g&-# $#r#) 'er"(n'r(->. Ti$#" #$# +eny#"i' "r(ni, -#in =K#r$i(?#,"&-er* PPOM $#n Gin7#->.

$. Ke'i$#",em+&rn##n Re,+(n Ne&r(en$("rin P#,ien $eng#n $i#be'e, me--i'&, y#ng 'er"(n'r(-. e. Mer("("

P#,ien 'i$#" #$# ri5#y#' mer("(". 3. A-")()(- $#n (b#'8(b#'#n

P#,ien 'i$#" #$# ri5#y#' #-")()(-i". @. An#-i,# D#'#

N( D#'# E'i(-(gi M#,#-#)

! DS 

a. _{P#,ien meng#'#"#n '#"&' $i-#"&"#n}

(+er#,i* "#ren# be-&m +ern#) men7#-#ni (+er#,i.

DO 

#. E",+re,i 5#7#) +#,ien 'eg#ng $#n bing&ng.

Tin$#"#n +embe$#)#n

em#,

2 DS 

a. _{P#,ien ber'#ny# mengen#i 5#"'&}

(+er#,i* #+#"#) ,e'e-#) (+er#,i -&"#ny# bi,# ,emb&).

b. _{Ke-&#rg# ber'#ny# ,e'e-#) (+er#,i}

)#r&, m(n$(" ber#+# )#ri -#gi. DO 

#. E",+re,i 5#7#) +#,ien 'eg#ng $#n bing&ng. K&r#ng in3(rm#,i mengen#i 'in$#"#n (+er#,i. K&r#ng +enge'#)&#n !/. Ren9#n# Ke+er#5#'#n

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T&7&#n  Se'e-#) $i-#"&"#n 'in$#"#n "e+er#5#'#n ,e-#m# !:!6 meni' $i)#r#+"#n 9em#, 'er#'#,i. Kri'eri# H#,i-  #. E",+re,i 5#7#) 'en#ng. b. i'#- ,ign $#-#m b#'#, n(rm#-. In'er?en,i 

#. Ob,er?#,i re,+(n 3i,i(-(gi, +#,ien

b. Per"en#-"#n $iri $#n #ngg('# 'im be$#) -#in

9. D(r(ng +#,ien &n'&" meng&ng"#+"#n "e9em#,#nny#

$. Beri m('i?#,i +#,ien mengen#i +r(,e, +eng(b#'#n y#ng )#r&, $i7#-#ni e. A7#r"#n 'e"ni" re-#",#,i $#n $i,'r#",i

3. Beri in3(rm#,i mengen#i 'in$#"#n (+er#,i g. K(-#b(r#,i +emberi#n (b#' +enen#ng

). Pin$#)"#n "e "#m#r (+er#,i ,e'e-#) +#,ien 'en#ng

2. K&r#ng +enge'#)&#n b.$. "&r#ng in3(rm#,i mengen#i 'in$#"#n (+er#,i.

T&7&#n  Se'e-#) $i-#"&"#n 'in$#"#n "e+er#5#'#n ,e-#m# !:!6 meni' +#,ien menger'i mengen#i 'in$#"#n (+er#,i y#ng #"#n $i7#-#ni.

Kri'eri# )#,i- 

#. Men&n7&""#n +em#)#m#n mengen#i 'in$#"#n (+er#,i b. P#,ien m#m+& meng&-#ng "emb#-i +en7e-#,#n

9. Ber+#r'i,i+#,i $#-#m ren9#n# +er#5#'#n In'er?en,i 

#. Beri"#n +en7e-#,#n mengen#i 'in$#"#n (+er#,i.

b. Beri"#n in3(rm#,i +#$# +#,ien 'en'#ng 5#"'& (+er#,i* )#-8)#- y#ng #"#n $i#-#mi (-e) +#,ien ,e-#m# +r(,e, (+er#,i* men&n7&""#n 'em+#' "#m#r (+er#,i* 'im be$#)* $--.

9. G&n#"#n b#)#,# y#ng ,e$er)#n# $#n 7e-#,.

$. Beri "e,em+#'#n +#$# +#,ien $#n "e-&#rg#ny# &n'&" ber'#ny# e. K(re",i +enger'i#n +#,ien y#ng ,#-#).

3. Pin$#)"#n "e "#m#r (+er#,i ,e'e-#) +#,ien +#)#m mengen#i 'in$#"#n (+er#,i !!. Im+-emen'#,i

W#"'& N(.$ :

Tin$#"#n H#,i- P#r#3

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!/.2/ !/.26 /@.2 2 2 !*2 9em#, +#,ien. Mem+er"en#-"#n $iri $#n #ngg('# 'im be$#) -#in

Men$(r(ng +#,ien &n'&" meng&ng"#+"#n "e9em#,#nny#.

Memberi"#n +en7e-#,#n mengen#i 'in$#"#n (+er#,i.

Memberi"#n in3(rm#,i +#$# +#,ien 'en'#ng 5#"'& (+er#,i* )#-8)#- y#ng #"#n $i#-#mi (-e) +#,ien ,e-#m# +r(,e, (+er#,i $#n

'im be$#).

Memberi "e,em+#'#n +#$# +#,ien $#n "e-&#rg#ny# &n'&" ber'#ny#

Memberi m('i?#,i +#,ien mengen#i +r(,e, +eng(b#'#n y#ng )#r&, $i7#-#ni

Meng#7#r"#n 'e"ni" re-#",#,i $#n $i,'r#",i

Meng(b,er?#,i re,+(n 3i,i(-(gi, 9em#, +#,ien.

+#-ing '#"&' 7i"# $ir#5#' $i R&m#) S#"i'* ber(b#' "e,ini #'#, "em#&#n "e-&#rg# P#,ien meng#'#"#n +&,ing

O e",+re,i 5#7#) 'eg#ng* +#-+i'#,i =>

S+#,ien meng#'#"#n menger'i mengen#i 'in$#"#n (+er#,i* b#)5# #"#n $i#mbi- 7#ring#n y#ng m#'i y#i'& 7#ri "e$&# * $#n n#n'i #"#n $ibi&, #re# $#$# "e b#5#) (-e) 'im be$#) #n'#r# -#in $("'er $#n +er#5#'.

O+#,ien "((+er#'i3* +#,ien 'er-i)#' +#)#m.

S+#,ien ber'#ny# mengen#i b#g#im#n# r#,#ny# ,e'e-#) $i(+er#,i P#,ien meng#'#"#n menger'i #+# y#ng #"#n $ir#,#"#n ,e'e-#) (+er#,i* y#i'& nyeri* $#n #"#n $iberi"#n (b#' #n'i nyeri. OP#,ien "((+er#'i3

S P#,ien meng#'#"#n menger'i 'en'#ng +en'ingny# (+er#,i y#ng

#"#n $i7#-#ni.

O P#,ien $#+#' mem+r#"'i""#n 'e"ni" n#3#, $#-#m. e",+re,i

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!/.1/ !*2 Memin$#)"#n "e "#m#r (+er#,i ,e'e-#) +#,ien 'en#ng $#n +#)#m mengen#i 'in$#"#n (+er#,i

5#7#) 'en#ng.+#-+i'#,i =8> P#,ien $i+in$#)"#n "e "#m#r (+er#,i ! , HR@/:;mn' RR!0:;mn' !2. E?#-&#,i W#"'& N(.D : D#'# SOAP

!/.1/ ! S P #,ien m eng#'#"#n m enger'i ' en'#ng + en'ingny# (+er#,i y#ng #"#n $i7#-#ni.

O E",+re,i 5#7#) 'en#ng +#,ien bi,# me-#"&"#n n#3#, $#-#m +#-+i'#,i =8>

P#,ien $i+in$#)"#n "e "#m#r (+er#,i ! , HR@/:;mn' RR!0:;mn'

A M#,#-#) 'er#'#,i

P Hen'i"#n ,em&# in'er?en,i

!/.1/ 2 S +#,ien meng#'#"#n menger'i mengen#i 'in$#"#n (+er#,i* b#)5# #"#n $i#mbi- ,e$i"i' '&-#ngny# &n'&" +emeri",##n ,e-#n7&'ny#* $#n n#n'i #"#n $ibi&, #re# $#$# "e b#5#) (-e) 'im be$#) #n'#r# -#in $("'er $#n +er#5#'.

O +#,ien "((+er#'i3 e",+re,i 5#7#) 'en#ng P#,ien $i+in$#)"#n "e "#m#r (+er#,i !

A M#,#-#) 'er#'#,i

B. In'r# O+er#'i3

I. D#'# in'r#(+er#'i3

#. Per,i#+#n +,i"(-(gi, +#,ien* b#)5# +#,ien meng#'#"#n ,&$#) -ebi) ,i#+ men7#-#ni 'in$#"#n (+er#,i. P#,ien m#,&" "#m#r (+er#,i ! =,#'&> 7#m !/.1/ WIB. P#$# +&"&- !/.16 WIB +#,ien $i-#"&"#n regi(n#- #n#e,'e,i $eng#n mengg&n#"#n De"#in ,+in#- )e#?y /*6C 4m- $#n $i'i$&r"#n $eng#n mengg&n#"#n Mi$#(-#m 6 mg.

(10)

Menyi#+"#n m(ni'(r. P(,i,i +#,ien ,emi 3(5-er $eng#n "#"i "iri $i'inggi"#n* b#gi#n b#5#) "#"i "iri $ig#n7#- b#n'#-. P#,ien memi-i) &n'&" 'i$&r.

Men$e,in3e",i "&-i' $#er#) (+er#,i. Men&'&+ $#er#) -#in. Mem+er'#)#n"#n ,&rgi9#- #,e+,i. D#ri -&"# "e-&#r $#r#) ,eg#r 2//99* +&, 6/ 99. Di-#"&"#n $ebri$emen' $#n #m+&'#,i &n'&" meng#mbi- 7#ring#n y#ng m#'i.

M(ni'(ring #. i'#- ,ign* 7#m !/.1/8!!.!/. Te"#n#n $#r#)* +#$# ren'#ng n(rm#- =!!0;4mmHg8!2@;</mmHg> HR* +#$# ren'#ng n(rm#- =0<8<6:;meni'> RR* +#$# ren'#ng n(rm#- =!48!:;meni'> S+O2* +#$# ren'#ng n(rm#- =@@8!//C> b. Tr#,3&,i

Ti$#" $i-#"&"#n 'r#n3&,i $#r#) 9. In3&,

#ir#n in3&, y#ng m#,&"  RL 6// 99 $#n Fim#)e, 26/ 99 $. O&'+&' &rine

4//99

Men9&9i $#er#) (+er#,i;irig#,i. Memb#-&' -&"# be$#) $#n memin$#)"#n +#,ien "e RR

Per,i#+#n +#,ien

P(,i,i +#,ien  S&+in#,i

Ane,'e,i  Regi(n#- #ne,'e,i TD !!/_;

</ mmHg

N#$i  <4 :;meni' RR 2/ :;meni'

Pem#,#ng#n  be$ ,i$e m(ni'(r W#"'&  8

A)-i #n#,'e,i  Dr. S. S.An O+er#'(r  Dr. B. S+.B A,i,'en  R In,'r&men  F !. Per,i#+#n #-#' Set Bedah Jm-O?#ri&m "-em !

(11)

S'i" me,) be,#r G&n'ing ben#ng G&n'ing 7#ring#n Pin,e' #n#'(mi, Pin,e' ,ir-&gi, D&" "-em N#-3&$er K-em #r'eri

K-em -&r&, Germ#ny K(m L#ngen be9" Beng"(" Se-#ng ,&9'i(n J#r&m 9&''ing J#r&m '#+er Ben#ng ,i$e 2;/ Set tambahan: Ker("#n K#n&- ,&9'i(n (&'er ! ! 2 2 2 0 2 4 2 1 2 ! ! 2 4 2 ! ! ! T('#- 1@

Set Linen Jm- Bahan habis pakai

Jm-Per-#" D&" be,#r D&" -&b#ng D&" "e9i-D&" ,e$#ng ! ! ! ! 2 H#n$,9((n K#,## Bi,'&ri n( 22 A-"()(- @/C Be'#$ine S#?-(n N#-1 +,g !// 2 !6/ 99 !6/ 99 6/ 99 2// 99 T('#- 0 2. Pen#'#-#"#,#n##n;in,'r&men N( Tin$#"#n Per#-#'#n ! De,in3e",i K(m !* be'#$in !6/ 99* #-9()(- !6/ 99* (?#ri&m "-em !* ,#?-(n 6/ 99* "#,,# !/ -br 2 Dr#++ing D&" be,#r !* $&" -&b#ng !*

$&" "e9i- !* $&" ,e$#ng 2* $&" "-em 1.

1 Me-#"&"#n ,#y#'#n +#$# "&-i' ,#m+#i ('('

Bi,'&ri n( 22* "#,,# !/* "-em #r'eri 2*

Pin,e' 9ir&gi, 2* g&n'ing 2 4 Member,i)"#n #re# $ebri$emen' Ker("#n !

6 Men9&9i $#er#) (+er#,i N#L 6//

(12)

K#,,# #5#-!// #")ir!//  Dre,,ing K#,,# ,'eri- -emb#b 0 $#n

"ering 6.

< B#-&' -&"# K#,# g&-&ng 2.

II. An#-i,# D#'#

N( D#'# E'i(-(gi M#,#-#)

! DS  8

DO  P#,ien '#m+#" 'i$&r $#ri -&"# "e-&#r $#r#) ,eg#r 2//99* 9#ir#n +&, 6/99 D#'# +emeri",##n -#b(r#' +re (+ Hb!!*4 gr;$-H'16 ?(- C Per$#r#)#n Re,i"( g#ngg&#n "e,eimb#ng#n 9#ir#n $#n e-e"'r(-i'

2 DS  P#,ien meng#'#"#n ingin 'i$&r ,#7#.

DO  "e$&# '#ng#n $i 3i",#,i $#n "e$&# "#"i 'i$#" $i3i",#,i*

P#,ien 'er-i)#' 'eg#ng

E3e" #n#,'e,i $#n +embe$#)#n

Re,i"( "e9e-#"##n

III. Ren9#n# "e+er#5#'#n

!. Re,i"( g#ngg&#n "e,eimb#ng#n 9#ir#n $#n e-e"'r(-i' b.$ +er$#r#)#n

T&7&#n  Se'e-#) $i-#"&"#n 'in$#"#n "e+er#5#'#n ,e-#m# +r(,e, in'r# (+er#,i +#,ien 'i$#" meng#-#mi g#ngg&#n "e,eimb#ng#n 9#ir#n $#n e-e"'r(-i'.

Kri'eri# )#,i- 

#ir#n $#n e-e"'r(-i' ,eimb#ng In'er?en,i 

#. eg#) +er$#r#)#n ber-ebi) b. M(ni'(r )i$r#,i

9. K(n'r(- +er$#r#)#n $. M(ni'(r ?i'#- ,ign

e. Si#+"#n "em&ng"in#n 'r#n3&,i 3. M(ni'(r 9#ir#n y#ng me-e5#'i D

g. Pin$#)"#n +#,ien "e RR ,e'e-#) ,e-e,#i 'in$#"#n in'r# (+er#'i3 2. Re,i"( "e9e-#"##n b.$ e3e" #n#,'e,i $#n +embe$#)#n

T&7&#n  ,e'e-#) $i-#"&"#n 'in$#"#n "e+er#5#'#n ,e-#m# +r(,e, in'r# (+er#,i +#,ien 'i$#" 'er7#$i "e9e-#"##n

(13)

Kri'eri# )#,i-

#. Ti$#" #$# 7#r&m y#ng 'er'ingg#- b. P#,ien 'i$#" 7#'&)

9. Fi,i(-(gi, +#,ien 'i$#" 'erg#ngg& In'er?en,i

#. P#,'i"#n "e#m#n#n +#,ien $eng#n 'in$#"#n +embe$#)#n b. Beri ,e$#'i?e 7i"# +#,ien meng)en$#"i &n'&" $i'i$&r"#n.

9. J#g# +(,i,i imm(bi-e

$. M(ni'(r +engg&n##n "#,# $#n 7#r&m in,'r&men' e. P#,#ng +eng#m#n 'em+#' 'i$&r =3i",#,i>

3. P#,#ng #-#' gr(&n$ing $#n +#,'i"#n b#)5# ,em&# #-#' y#ng $i g&n#"#n 'e-#) ,i#+ ,e+er'i  in3&,e* m(ni'(r* in,'r&men'

g. Per'#)#n"#n "e#$##n #,e+,i, ,e-#m# +embe$#)#n ). J#g# "e,e'#bi-#n 'em+er#'&r +#,ien

i. M(ni'(r 'er7#$iny# )i+('ermi* )i+('en,i* $#n )i+er'ermi m#-ign#n 7. B#n'& +en&'&+#n -&"# (+er#,i

". Pin$#)"#n +#,ien $#ri r&#ng (+er#,i "e r&#ng +em&-i)#n;PAU

I. Im+-emen'#,i W#"'& N(.D : Tin$#"#n H#,i-P#r# 3 !/.1/8 !!./6

!*2 Mem#,#ng +eng#m#n 'em+#' 'i$&r =3i",#,i>

Mem#,#ng #-#' gr(&n$ing $#n mem#,'i"#n b#)5# ,em&# #-#' y#ng $i g&n#"#n 'e-#) ,i#+*

Memberi"#n in7.mi$#(-#m 6 mg*

Mem(ni'(r )i$r#,i Mem(ni'(r ?i'#- ,ign Mem(ni'(r 9#ir#n y#ng me-e5#'i D

S P#,ien meng#'#"#n memi-i) 'i$&r*

P#,ien meng#'#"#n ,e'&7&. O A-#' gr(&n$ing

'er+#,#ng $#n ,em&# #-#' y#ng $ig&n#"#n 'e-#) ,i#+ P#,ien 'er+#,#ng 3i",#,i +#$# "e$&# '#ng#n.

K(n$i,i +#,ien #m#n Ob#' mi$#(-#m m#,&" me-#-&i in'r#?en# $#n P#,ien 'er'i$&r*

(14)

!/.6/ !/.1/8 !!./6 !!./6 !!.!/ ! ! ! 2 Mem(ni'(r )i$r#,i Men9eg#) +er$#r#)#n ber-ebi) Meng(n'r(- +er$#r#)#n Memb#n'& +en&'&+#n -&"#

Mem(ni'(r 9#ir#n y#ng me-e5#'i D Intake RL 6// 99 Fim#)e, 26/ 99 output +er$#r#)#n 2// 99 +&, 6/ 99 &rine 4// 99 IWL 1/ 99 BC : INTAKE –OUTPUT 6/80</ /

Memin$#)"#n +#,ien $#ri r&#ng (+er#,i "e r&#ng

Hi$r#,i #$e"&#' in3&, RL ren'#ng TD !!0;4mmHg8 !2@;</mmHg ren'#ng HR0<8<6:;mn' ren'#ng RR!48!:;mn' ren'#ng S+O2@@8!//C. Ti$#" #$# #-#' $#n "#,,# y#ng 'er'ingg#-S 8

O #ir#n RL )#bi,* m#,&" 9#ir#n "(-(i$.

S 8

O +er$#r#)#n 2// 99 '#n$#8'#n$# "e"&r#ng#n 9#ir#n=8> 'r#n3&,i =8> . L&"# 'er'&'&+ "#,,# ,'eri-.

S 8

O B  / 99

K(n$i,i 3i,i(-(gi, +#,ien

n(rm#-S

(15)

+em&-i)#n KUb#i"*

"e,#$#r#n,(mn(-en P#,ien ,&$#) $i+in$#)"#n $i RR

. E?#-&#,i

W#"'& N(.D

: D#'# SOAP

!!.!/ ! S8

O Ke,#$#r#n,(mn(-en* KU b#i"

TD!2!;/mmHg HR<:;mn' RR!0:;mn' S+O2!//C +er$#r#)#n2//99* +&,6/99 '#n$#8'#n$# "e"&r#ng#n 9#ir#n=8>

'r#n3&,i =8>

(&'+&' &rine4//99 B  / 99

A M#,#-#) 'er#'#,i

P Hen'i"#n ,em&# in'er?en,i !!./6 II S  8

O Ke#$##n +#,ien #m#n ,e-#m# +r(,e, +embe$#)#n Ti$#" #$# "#,# $#n 7#r&m in,'r&men'

'er'ingg#-K(n$i,i 3i,i(-(gi, +#,ien n(rm#-;'i$#" 'erg#ngg& A M#,#-#) 'er#'#,i

. P(,' O+er#'i3

I. D#'# P(,' O+er#,i Di RR

P#,ien +(,' (+er#,i $ebri$emen' &-"&, +e$i, ,ini,'r# $eng#n regi(n#- #n#e,'e,i* m#,&" RR 7#m !!.!/ WIB. K(n$i,i +#,ien -em#)* "e,#$#r#n ,(mn(-en* 'i$#" 'er+#,#ng re,'r#in.

K(n$i,i 7#-#n n#3#, ber,i)* 'i$#" #$# ,&mb#'#n 7#-#n n#3#,* 'i$#" #$# $i,'re,, +ern#3#,#n* 'i$#" #$# ,e"re'* 'i$#" #$# m&n'#)#n $#n ,&#r# n#3#, br(n"(?e,i"&-er.

Pern#3#,#n +#,ien ,+(n'#n $eng#n support n#,#- "#n&- O2 1 -i'er;meni'*

RR!<:;meni'* e",+#n,i +#r& ,ime'ri,* 'i$#" #$# +ening"#'#n +engg&n##n ('(' b#n'& n#3#, $#n ir#m# n#3#, reg&-er. Pemberi#n +(,i,i semi fowler $eng#n $ig#n7#- b#n'#-.

K(n$i,i ,ir"&-#,i y#i'& 'e"#n#n $#r#) !2/;</ mmHg* N@ "#-i;meni'* ,&)& 10*6/_{* S+O}

(16)

e",'remi'#,* &rine (&'+&' 4// 99. Ter+#,#ng bedside monitor  'er#+i 9#ir#n in'r#?en# $eng#n in3&, Fim#)e, 2/ '+m.

P#,ien meng#'#"#n mer#,# meng#n'&". !. An#-i,# D#'#

N( D#'# E'i(-(gi M#,#-#)

! DS  8

DO  KU  -em#)* "e,#$#r#n  ,(mn(-en * 'i$#" 'er+#,#ng re,'r#in* TD  !2/;</ mmHg * N @ : ;meni'* R  !< :;meni'* S  10*6 /_.

Tr#n,+(r' $#n 'r#n,3er "e RR

Re,i"( 9i$er#

2 DS P#,ien meng#'#"#n mer#,# ng#n'&" DO KU -em#) "e,#$#r#n ,(mn(-en* P(,' RA S+O2  @@ C

Pern#3#,#n +#,ien ,+(n'#n $eng#n support n#,#- "#n&- O2 1 -i'er;meni'*

RR!<:;meni'* e",+#n,i +#r& ,ime'ri,* 'i$#" #$# +ening"#'#n +engg&n##n ('(' b#n'& n#3#, $#n ir#m# n#3#, reg&-er.

Pemberi#n +(,i,i semi fowler $eng#n $ig#n7#- b#n'#-. E3e" ,#m+ing #n#e,'e,i Re,i"( +(-# n#3#, 'i$#" e3e"'i3 2. Ren9#n# "e+er#5#'#n

!. Di#gn(,#  Re,i"( 9i$er# b.$ 'r#n,+(r' $#n 'r#n,3er "e RR

T&7&#n  Se'e-#) $i-#"&"#n 'in$#"#n "e+er#5#'#n ,e-#m# !:@/ meni' $i)#r#+"#n +#,ien 'i$#" 'er7#$i 9i$er#.

Kri'eri# H#,i- 

#. P#,ien 'i$#" 'er7#'&) $#ri br#n"#r

b. P#,ien $#-#m "(n$i,i #m#n $#n ny#m#n In'er?en,i 

#. Pi$#) +#,ien $eng#n ben#r $#n #m#n $eng#n mengg&n#"#n br#n"#r b. Beri +(,i,i ben#r $#n #m#n =,&+in#,i>

9. P#"#i"#n ,e-im&'

$. Beri"#n +#,ien +#$# 'em+#' 'i$&r y#ng ny#m#n $#n +#,#ng ,i$e r#i-ny# e. M(ni'(r br(m#ge ,9(re

3. Pin$#)"#n "e r&#ng +er#5#'#n ,e'e-#) br(m#ge ,9(re /.

(17)

T&7&#n  ,e'e-#) $i-#"&"#n 'in$#"#n "e+er#5#'#n ,e-#m# ! : @/ meni' "e+er#5#'#n +(-# n#3#, +#,ien e3e"'i3

Kri'eri# )#,i-  +(-# n#3#, n(rm#-* 'i$#" #$# b&nyi '#mb#)#n* TT $#-#m b#'#, n(rm#- =TD  !2/;@/ mmHg* N  /8</ :;meni'* R  !0824 :;meni'* S  10*081*2

/_{* S+O2  >* 'i$#" #$# b#'&"* e",+#n,i +#r& mengemb#ng n(rm#-* +#,ien $#+#'}

mem+er'#)#n"#n 3&ng,i +ern#3#,#n (+'im#-In'er?en,i 

#. P#,#ng be$ ,i$e m(ni'(r

b. M(ni'(r +(-# n#3#, $#n ?i'#- ,ign 'erm#,&" S+O2 ,e'i#+ !6 meni' 9. Beri +(,i,i ,emi 3(5-er

$. An7&r"#n n#3#, $#-#m

e. A&"&-'#,i #$#ny# b&nyi n#3#, '#mb#)#n

3. Pin$#)"#n +#,ien "e r&#ng +er#5#'#n ,e'e-#) $i+#,'i"#n +ern#+#,#nny# ,'#bi-g. K(-#b(r#,i +emberi#n O2 1. Im+-emen'#,i W#"'& N(.$ : Tin$#"#n H#,i-P#r# 3 !!.!/ !!.!68 !2.// ! 2

Memin$#)"#n +#,ien $eng#n mengg&n#"#n br#n"#r*

mem+(,i,i"#n ,&+in#,i

Mem#,#ng be$,i$e m(ni'(r Mem(ni'(r +(-# n#3#, $#n ?i'#-,ign 'erm#,&" S+O2 ,e'i#+ !6 meni'

S 8

O +#,ien 'er+(,i,i ,&+in#,i $#n +#,ien #m#n ,#m+#i $i RR. S  8 O  KU -em#)* "e,#$#r#n 9(m+(,men'i,* +(-# n#3#, n(rm#-* 'i$#" #$# b&nyi '#mb#)#n* 'i$#"

#$# b#'&"* e",+#n,i +#r& mengemb#ng n(rm#-*

(18)

!!.2/ !2./6 !2.!/ !*2 2 2

Mem(ni'(r br(m#ge ,9(re Mem+(,i,i"#n ,emi 3(5-er* Meng#n7&r"#n &n'&" n#3#, $#-#m*

Meng#&"&-'#,i #$#ny# b&nyi n#3#, '#mb#)#n

Mem(ni'(r br(m#ge ,9(re

Mem(ni'(r +(-# n#3#, $#n ?i'#-,ign 'erm#,&" S+O2 'i#+ !6 meni'

Memin$#)"#n +#,ien "e r&#ng +er#5#'#n ,e'e-#) br(m#ge

,9(re /

+#,ien $#+#'

mem+er'#)#n"#n 3&ng,i +ern#3#,#n (+'im#-* +#,ien ,&$#) 'er+#,#ng be$,i$e m(ni'(r * ren'#ng

TD !!/;/mmHg8 !2/;@/mmHg ren'#ng HR </8<0:;mn' ren'#ng RR!48!<:;mn' ren'#ng S+O2@@8!//C. S 8 O  br(m#ge ,9(re 1 $eng#n "ri'eri# 'i$#" $#+#' mengg#ng"#' "#"i* +#,ien $#-#m +(,i,i ,emi 3(5-er* +#,ien 'er-i)#' bi,# me-#"&"#n n#3#, $#-#m* 'i$#" #$# b&nyi n#3#, '#mb#)#n* b&nyi n#3#, ?e,i"&-er S  8 O  br(m#ge ,9(re / $eng#n )#,i- $#+#' meng#ng"#' '&ng"#i b#5#) S  8 O  ren'#ng TD !!/;/mmHg8 !2/;@/mmHg ren'#ng HR </8<0:;mn' ren'#ng RR!48!<:;mn' ren'#ng S+O2@@8!//C. +#,ien $i+in$#)

"eb#ng,#- (-e) +er#5#' b#ng,#-.

4. E?#-&#,i

W#"'& N(.D

: D#'# SOAP

!2.!/ ! S 8

(19)

"(n$i,i #m#n $#n ny#m#n* TD  !2/;</ mmHg * N @ : ;meni'* R  !< :;meni'* S  10*6 /_{* br(mege ,9(re / $eng#n}

"ri'eri# $#+#' meng#ng"#' '&ng"#i b#5#). A M#,#-#) 'er#'#,i

!2.!/ 2 S  P#,ien meng#'#"#n 'i$#" ,e,#" n#3#,

O KU -em#)* "e,#$#r#n 9(m+(,men'i,* +(-# n#3#, n(rm#-* 'i$#" #$# b&nyi '#mb#)#n* 'i$#" #$# b#'&"* e",+#n,i +#r& mengemb#ng n(rm#-* +#,ien $#+#' mem+er'#)#n"#n 3&ng,i +ern#3#,#n (+'im#-* TD  !2/;</ mmHg * N @ : ;meni'* R 

!< :;meni'* S  10*6 /_{* S+O2  @@ C}

A M#,#-#) 'er#'#,i